Medicaid is a public health insurance program designed to provide medical assistance to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Authorized as Title XIX of the Social Security Act in 1965, the program is a joint partnership, funded by both the federal government and individual states. While federal guidelines set a broad national framework, each state has flexibility to determine its own eligibility standards, the scope of services offered, and the rates paid. Telehealth refers to the use of telecommunications technology, such as audio and video connections, to deliver healthcare services from a distance, improving access for patients facing geographical or logistical barriers. The variability inherent in the federal-state structure directly affects what telehealth services Medicaid covers, creating a patchwork of coverage rules across the country.
The Foundational Role of State-Specific Medicaid Rules
There is no single national Medicaid policy for telehealth, making the state-level rules the most important factor in determining coverage. The federal Centers for Medicare & Medicaid Services (CMS) establishes the baseline, but states use their authority under the Title XIX framework to customize their programs. This autonomy is primarily exercised through State Plans and waivers, which allow each state to define exactly how telehealth is integrated into its Medicaid program.
States have the power to define eligible provider types, set their own reimbursement rates, and determine the specific locations where telehealth services can occur. A state determines who can be the “distant site” provider and what locations qualify as the “originating site” where the patient is situated. While the patient’s home is increasingly allowed as an originating site, many states still have restrictions or only allow it for specific services.
Furthermore, states determine the scope of practice for providers delivering telehealth, ensuring services align with state licensing requirements. The administrative rules surrounding distant and originating sites, eligible providers, and payment structure are the mechanisms by which states manage the availability of technology-delivered care.
Common Categories of Covered Clinical Services
The most widely and consistently reimbursed telehealth services fall under behavioral health. Mental health and substance use disorder (SUD) treatments, including psychotherapy and medication-assisted treatment (MAT), are frequently covered. These services were often the first to be broadly expanded via telehealth due to high demand and clinical appropriateness for remote delivery.
Primary care consultations, such as routine check-ups, follow-up visits, and medication management, are also commonly covered. This allows for the management of chronic conditions and minor acute illnesses without requiring an in-person visit. Many states have permanent policies covering services like physician visits and outpatient hospital services when delivered remotely.
Coverage for specialty care is often more variable and state-dependent than for behavioral or primary care. Some states cover services like teledermatology, telecardiology, or speech, occupational, and physical therapies. Eligibility for these services may be limited to specific circumstances or provider types, often requiring specific state policy updates.
Approved Telehealth Modalities and Technology
The method of service delivery, or modality, is a key component of Medicaid telehealth policy. The most common and widely covered modality is synchronous, or live video, which involves real-time, two-way interactive communication. This modality closely mimics an in-person visit and is reimbursed by all state Medicaid programs. Some states also permit audio-only telephone calls for certain services, particularly behavioral health, to ensure access for beneficiaries without reliable internet or video equipment.
Asynchronous, or “store-and-forward,” involves the electronic transmission of medical information, such as diagnostic images or patient data, for a provider to review later. Coverage for store-and-forward is more restrictive than live video, often limited to specific specialties like dermatology or radiology in a limited number of states. Remote Patient Monitoring (RPM) involves using technology to collect and transmit biometric data—like blood pressure or glucose levels—from the patient’s home to the provider. RPM coverage is frequently limited to specific chronic conditions and often requires specific state approvals or is restricted to certain patient populations. All technological platforms must comply with the Health Insurance Portability and Accountability Act (HIPAA).
Patient Eligibility and Cost-Sharing Rules
Eligibility for Medicaid telehealth coverage is tied directly to qualification for the standard state Medicaid program. A beneficiary must meet the state-specific criteria related to income, family size, and disability status to be enrolled. The patient must be a currently eligible Medicaid recipient for any remote service to be covered.
Federal rules impose significant limitations on the financial burden placed on Medicaid beneficiaries. Federal law restricts the amount a state can charge for covered services, including those delivered via telehealth. Consequently, most states charge no co-payments or only small, nominal co-payments for telehealth visits, depending on the service and the patient’s eligibility group.
The concept of “parity” also plays a role in the financial landscape. Payment parity means that a telehealth service must be reimbursed at the same rate as the comparable in-person service, a growing trend across states. While not all states have explicit payment parity laws, the financial structure ensures beneficiaries have access to remote care without facing significant out-of-pocket costs.