Telehealth services have risen to prominence in the last couple of years. They’re alternatives to in-person doctor visits for those who prefer to receive care remotely for any number of reasons. But does Medicaid cover telehealth in your state?
In this guide, we’ll discuss what telehealth services offer and how states administer them.
What Is Telehealth?
Telehealth and telemedicine are ways to connect with your doctor or physician to get health care without physically visiting your doctor’s office. Telehealth represents a rapidly growing segment of the healthcare industry, especially since the beginning of the COVID-19 pandemic.
With telehealth, a patient can interact with their doctor through video chat, text messages, or phone calls. The doctor may set up remote monitoring to keep tabs on the patient, including the use of devices to check on the patient’s condition and monitor their vital signs.
How Telehealth Works
Telehealth relies on frequent communication between patients and physicians. The patient sends information about their ongoing health conditions: blood pressure, blood sugar, weight, and other necessary data they check themselves.
The patient can also forward images, medical records, or X-rays from another doctor to depict their current condition or describe symptoms, a practice known as “store-and-forward.”
Similarly, the doctor in a telehealth exchange may send notifications for the patient to take medication or other health measures like exercise. They can offer suggestions on home care or managing stress and diet, as well as motivation to stay current with the medical treatment plan.
Regional Telehealth Differences
It’s important to note that available telehealth options differ from state to state. Some states have scaled back on telehealth visits recently even as COVID-19 persists, while other states are struggling with their medical boards' reluctance to allow interstate telehealthcare.
However, many other states have embraced the cost-cutting benefits of telehealth and encouraged the practice to mature and develop.
Does Medicaid Cover Telehealth?
Since Medicaid coverage is administered at the state level, as you might expect, Medicaid coverage of telehealth visits varies from state to state.
Some states cover all major sources of telemedicine services. In many states, Medicaid reimburses live-video telehealth services, along with some remote monitoring and store-and-forward practices.
Other states may cover telehealth services only for crisis-related situations. A few states leave Medicaid reimbursement issues up to the individual providers.
As telehealth is a burgeoning industry, some states have yet to specifically address some aspects of Medicaid telehealth coverage. Some of the most common components of telehealth are not adequately addressed in policies yet in some locations.
Massachusetts, for example, revised its state's Medicaid policy on and definition for telehealth in 2021 but has yet to address whether it will reimburse remote healthcare monitoring.
In the case of store-and-forward, some states explicitly cover it, and others explicitly do not — but many states simply haven’t expressed a policy one way or the other.
Does Medicaid cover telehealth in your state? Fortunately, there’s a resource that can give a little more clarity on your state’s Medicaid policy on telehealth.
The Center for Connected Health Policy (CCHP) has a telehealth webpage that outlines how each state is currently handling Medicaid reimbursements for telehealth. Scroll to “look up policy by jurisdiction,” click on your state, and on the next page, scroll down to the “Medicaid” section to get an overview of your state’s policies.
How Much Does Telehealth Generally Cost?
As you might expect, the cost of telehealth varies according to several considerations, like whether the patient has Medicaid or another form of insurance coverage, which provider they’re meeting with, and the condition being treated. With this in mind, here is a general look at average costs for telehealth.
A 2017 study from Health Affairs found that a telemedicine visit for respiratory issues costs an average of $79. That price was about half the cost of an in-person visit, found to be $146. It’s a fraction of the average cost of a visit to the emergency room, which the study estimated to be $1,734.
In 2020, GoodRx Health sampled cost information from several telehealth providers for services like birth control, acne and cold sore treatment, and erectile dysfunction. They found that most online consultations were in the two-digit range — birth control visits, for example, averaged out to about $50.
The studies also found that certain telehealth providers charged more for prescription refills than online visits. Other services, like lab tests, may also cost substantially more than online consultation.
Some of the largest healthcare insurers — Blue Cross Blue Shield and Aetna, for example — are embracing telehealthcare as a cost-saving measure, encouraging some policyholders to take advantage of the option by waiving copays.
How to Find a Telehealth Doctor
If you currently have a family physician, ask them about their existing options for telehealth services.
Alternatively, you can contact your health insurance provider. Medicaid has several resources that can help you to determine coverage for visits to physicians that offer telehealth services. They may also be able to refer you to approved companies that perform telemedicine through web portals or apps.
Those who have limited or no health insurance may also find a nearby health center that can accommodate their telehealth needs.
The Bottom Line on Telehealth
The possibilities of telehealth are enormous. But as with any segment of the healthcare industry, availability and reimbursement policies heavily depend on where you live and what condition you’re seeking treatment for. Get all of the information you can in advance of scheduling a telehealth session.
