Brief Medicaid Reimbursement for Telehealth

States may reimburse for telehealth under Medicaid if the service satisfies federal requirements of efficiency, economy and quality of care. Extensive control is given to states to decide how to structure and administer their Medicaid telehealth policies. Some Medicaid policies are enabled or mandated through state law, but a significant number take place within states’ executive branch through Medicaid rules and regulations.

States have the option to determine whether to allow for telehealth; what types of services to cover; where in the state it can be utilized; how it is implemented; reimbursement rates; and what types of qualified practitioners may deliver services via telehealth.

Medicaid reimbursement for all telehealth modalities—such as live video visits, store-and-forward, remote patient monitoring and audio-only—has increased significantly over the past the decade.

All state Medicaid programs include policies that provide some type of reimbursement for telehealth, but the scope of these policies varies among states. Twenty-five states stipulate Medicaid coverage and reimbursement for all four common telehealth modalities (live video, store-and-forward, remote patient monitoring and audio-only). Proponents of expanding Medicaid reimbursement say it improves access to care and allows patients to receive care in their homes and communities. However, opponents suggest that the quality of care is not always equivalent to in-person services and certain technologies may be unreliable for various services and treatments.

Live Video Reimbursement

All 50 states allow for Medicaid reimbursement for some aspect of live video telehealth visits, though variation exists across states. States determine-and may even restrict-the types of services, providers or the patient locations that are eligible for Medicaid reimbursement. A few states, such as North Carolina, specify certain types of providers eligible for Medicaid reimbursement for telehealth, while others, including Maine, allow reimbursement to any licensed provider. Some states explicitly list which services provided through telehealth can be reimbursed (e.g., mental health, primary care). Generally, states have been expanding these categories in recent years to allow greater reimbursement for a growing number of providers and services.

Store-and-Forward Reimbursement

Thirty-seven states allow for Medicaid reimbursement of store-and-forward-or the electronic transmission of medical images, documents and pre-recorded videos through secure electronic communication. In 2023, at least five states began offering reimbursement for store and forward services, though each state did so to a limited extent.

Radiology, dentistry and dermatology are the most common types of services delivered via telehealth to be reimbursed for store-and-forward services. Some states limit the types of settings and services for which store-and-forward services may be reimbursed. For example:

Georgia's Medicaid program only reimburses for store-and-forward services related to teledentistry in a school-based setting.

Washington's Medicaid program reimburses for teledentistry, teledermatology, behavioral health and consultations-TB services.

Remote Patient Monitoring Reimbursement

Laws and regulations in at least 42 states allow for Medicaid reimbursement of remote patient monitoring-the use of a specific technology to facilitate interaction between clinicians and patients at home or another remote location. At least three states added remote patient monitoring to their reimbursable modalities in their state Medicaid program in 2023. Some states also set limits on its use. For example:

Alabama allows reimbursement for providers caring for patients with diabetes, gestational diabetes, congestive heart failure, hypertension and pediatric asthma to participate in remote patient monitoring.

Oregon reimburses only dental providers for remote monitoring.

Audio-Only Reimbursement

Laws and regulations in at least 45 states and D.C. allow for Medicaid reimbursement of audio-only -real-time communication from provider to patient usually over the telephone. At least seven states added audio-only reimbursement in some capacity in 2023.