Telehealth Use Remains High Among Rural, Older Medicaid Members in Florida

Among Medicaid patients in Florida, those in rural areas and older than 65 used telehealth more than their counterparts, highlighting the need for continued access to virtual care for vulnerable populations, according to a new report.

The report, published by Elevance Health's Public Policy Institute, includes data from members enrolled in Florida's Simply Healthcare Medicaid plans. The data comprises medical encounter information from telehealth and in-person visits between January 2019 and December 2021.

Overall, telehealth use was low among Medicaid members throughout 2019. It peaked in 2020 and then leveled off in 2021. In April 2020, telehealth usage rose to 28 virtual visits per 1,000 members. By October 2021, that figure had dropped to a little over seven visits per 1,000 members.

Telehealth appeared to be a popular modality for primary care visits among Medicaid members. The proportion of telehealth visits increased to 24.2 percent of total primary care provider (PCP) visits and 4.6 percent of non-PCP visits in 2020, then dropped to 6.4 percent of PCP visits and 1.1 percent of non-PCP visits by December 2021, according to the report.

In addition to type of care, telehealth usage also varied by location. Rural Medicaid members' telehealth utilization was almost double that of urban members in April 2020 — with the former averaging 53.8 visits per 1,000 members versus the latter with 27.1 visits per 1,000 members.

This difference in utilization persisted through the end of last year. Rural members used telehealth services on average 1.4 times more than urban members in 2020 and 2021.

"The higher utilization among rural members may be a result of rural members finding it more appealing to participate in telehealth versus driving a considerable distance or this population becoming more familiar and comfortable with telehealth over time," the report states.

Similar to the variation by location, telehealth use among older Medicaid members was consistently higher than among those under the age of 65. The rate of older members' virtual care use rose to 115 visits per 1,000 members in April, dropping to just under 30 visits per 1,000 by October 2021. Meanwhile, the telehealth use rate for adults younger than 65 declined from its peak of 48 visits per 1,000 members in April 2020 to 5.7 per 1,000 members in December 2021.

Language did not appear to be a major barrier for Florida Medicaid members who wanted to utilize telehealth.

Members with an undetermined primary language used telehealth at rates approximately 3 times higher in 2020 and 2021 than those reporting a primary language. Further, Spanish-speaking members had slightly higher telehealth usage rates than those with other primary languages.

"This could be attributed to the disparities in COVID infection among the Hispanic and Latino populations in Florida, leading these [Spanish-speaking] members to opt for telehealth versus in-person visits," according to the report.

As providers continue to assess virtual care strategies amid evolving usage rates, the government has urged Medicaid to study the effects of telehealth use on the population. In April, the Government Accountability Office recommended that Medicaid collect information regarding the quality of telehealth that Medicaid beneficiaries receive and take the steps needed to enhance care based on this information.