Effect of State Medicaid Reimbursement Policies on Telehealth Visits in Community-Based Health Centers

Over the past several years, states began formally enacting telehealth policies to avail audio-only services for those unable to receive care in-person or over video. Such policies may be especially important in community-based health centers (CHCs) where, when telehealth is provided, it is primarily via audio-only. This retrospective study examined whether codified policies for Medicaid reimbursement and payment parity of audio-only telehealth were associated with greater use of telehealth.

Electronic health records for Medicaid-insured adults 18-64 years with visits to primary care (n = 700,051) and to behavioral health care (n = 95,136) in 433 primary care and 279 behavioral health care CHCs from April 1, 2021, to March 31, 2023, were analyzed. We collected policies using standardized legal mapping methods to identify audio-only telehealth policies having: (1) no reimbursement for telehealth, (2) reimbursement for telehealth, but no payment parity, or (3) reimbursement for telehealth, at parity.

One-third of primary care visits were telehealth, most of which were audio-only. Two-thirds of behavioral health care visits were telehealth, half of which were audio-only. Primary care visits in states with audio-only telehealth reimbursement policies not at parity were 4.8 percentage points more likely, and behavioral health care visits in states with reimbursement at parity were 3.2 percentage points more likely to use telehealth.

While audio-only telehealth reimbursement only modestly impacted overall telehealth utilization, Medicaid policies remain one of the few mutable factors important for primary care and behavioral health care access among safety-net populations.