Medicaid & Telemedicine Reimbursement

Medicaid reimbursement for telemedicine can vary widely from state-to-state.
Here’s a quick summary of the overall trends, and tips to navigate your own state’s Medicaid policies.

Almost all state Medicaid programs offer some sort of coverage for telemedicine, usually for live video. Some states reimburse for telemedicine with few restrictions, while others have more limited coverage.

A recent telemedicine policy report from the American Telemedicine Association (ATA) has an excellent, in-depth analysis of state Medicaid coverage for telemedicine.

Here are some of the key findings:

  1. 48 state Medicaid programs cover telemedicine
  2. 24 states cover telehealth for state employee plans
  3. 24 states and DC have no specific requirements for the patient location
  4. 25 states recognize the patient home as an originating site
  5. 82% of U.S. states cover telemedicine state-wide, with no restrictions on distance between provider and patient
  6. 15 states and DC don’t have limitations on which healthcare provider can do telemedicine

While the ATA report shows there’s still room for improvement, the nation is trending toward broader coverage for telemedicine.

As you’re researching your state Medical policies, also keep in mind that your state Medicaid handbook may not yet reflect the most recent policies passed. Some programs haven’t quite caught up yet to the flood of new telemedicine policy. That’s why it’s always best to contact your state Medicaid program and verify the telemedicine guidelines as you’re getting started.

Need some more help navigating your state Medicaid guidelines? No problem. Let’s drill down to the common requirements that many state Medicaid programs put on telemedicine coverage. Here’s a quick summary.

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Patient Setting

Patient setting (also called “originating site”) means where the patient is at the time of the telemedicine service. Traditionally, an eligible patient setting for telemedicine was limited to specific kinds of health facilities, often located within a Health Professional Shortage Area (HPSA).

With telemedicine technology increasingly moving to flexible online and mobile solutions that let patients and providers videochat via cell phone, this requirement can really get in the way. Many patients look to telemedicine visits as a way to get quick medical care in their homes.

The good news is that many state Medicaid programs are moving away from this restriction. Currently, 24 states plus DC don’t have any restrictions on the patient location, and 25 states recognize the home as an eligible originating site.

Geography restrictions

In the past, many state Medicaid programs only covered telemedicine in cases where patients lived far away from health providers, in remote or rural areas. States would set a specific distance requirement or geographic area that a patient would need to meet to be eligible for telemedicine.

Luckily, most states are trending away from this type of restriction now. In fact, 82% of states offer state-wide telemedicine coverage and have no geographic limits.

Eligible Providers

While all states with telemedicine coverage let physicians practice telemedicine, state Medicaid programs often restrict what other healthcare providers can also do telemedicine.

Currently 15 states plus DC don’t have this restriction – meaning any healthcare provider is eligible! The rest of the states have a set list of eligible providers, and only 4 states limit coverage to physicians only.

Covered Health Services

In the past, many state Medicaid programs only covered telemedicine in cases where patients lived far away from health providers, in remote or rural areas. States would set a specific distance requirement or geographic area that a patient would need to meet to be eligible for telemedicine.

Luckily, most states are trending away from this type of restriction now. In fact, 82% of states offer state-wide telemedicine coverage and have no geographic limits.

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