The COVID-19 pandemic caused major shifts in the way people congregate, employees work and individuals access healthcare. Some of these shifts may be temporary as the pandemic eases, while others may be permanent.
Fear of contracting the virus in a provider office setting led to significant increases in telehealth utilization during the pandemic. FairHealth’s monthly telehealth regional tracker found that as the pandemic raged in the US in October of 2020, nearly 6% of all insurance claim lines were for telehealth services. That represented a remarkable 3000+% increase from 2019.
Telehealth can be a convenient, cost-effective way to interact with health professionals. As a result, telehealth utilization will likely continue to grow in the years to come.
What does that mean in a Medicaid setting? Read on to learn about telehealth services in a Medicaid environment.
What is Telehealth?
According to Medicaid.gov, telemedicine, “seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site. This electronic communication means the use of interactive communications equipment that includes at a minimum, audio, and video equipment.” Essentially, from the Centers for Medicare and Medicaid and Medicare Services (CMS) perspective, telemedicine leverages audio and video technology to remotely connect a patient to a health professional. Though telehealth and telemedicine are generally used interchangeably, the Medicaid.gov website more narrowly defines telehealth as being akin to telemonitoring. States also generally have specific definitions of telehealth or telemedicine in their Medicaid environments. For this blog post, however, we’ll use a broader definition, meaning telehealth and telemedicine are generally synonymous.
The federal government sets the guardrails and states implement their own Medicaid programs. As a result, there isn’t a universal definition of which telehealth services are covered. For example, in Minnesota, telemonitoring, in which a patient uses a connected device to transmit health data to healthcare providers, is covered by the state’s Medical Assistance program in certain situations.
In addition to live video, other types of telehealth include store-and-forward, a service typically used in clinical specialties like dermatology or radiology. Essentially, the patient or their doctor forwards patient data to a specialist who remotely provides treatment recommendations. Another subset of telehealth is mobile health, which leverages cell phones and other mobile technologies to connect patient data with healthcare providers.
What’s the History of Telehealth in Medicaid?
In the 2000s, there was interest in using telehealth for behavioral health issues among rural Medicare beneficiaries. That interest led to growth in telehealth services, which eventually spilled into Medicaid programs. For example, in 2006, Minnesota’s Medicaid program began covering telehealth services for mental health care. By 2009, some commercial payers were also covering telemedicine services. In the past decade, many states began to mandate reimbursement parity for telemedicine and in-person service in their Medicaid programs. The COVID-19 pandemic accelerated telehealth utilization in state Medicaid programs.
Why is Telehealth More Difficult in the Medicaid Environment?
One of the larger obstacles is access to the technology required to use telehealth. According to a KFF analysis, before the pandemic, as many as 13% of Medicaid enrollees lived in a home without internet access and another 13% had Internet access but lacked a computer, meaning a cell phone was the only way they could access the Internet. Those numbers were higher for certain populations, like older Medicaid beneficiaries and rural enrollees.
Provider acceptance can also be problematic. Like Medicaid beneficiaries, providers need the infrastructure necessary to support telehealth. They need training on how to use the technology that supports telehealth. Plus, providers often experience difficulty acclimating to telehealth instead of face-to-face care. To help, the Coronavirus Aid, Relief, and Economic Security (CARES) Act provided millions of dollars to fund technology for certain healthcare providers in rural or medically underserved areas.
States also implemented provider outreach programs to help encourage the adoption of telehealth services. Nevada, which counts 15 of its 17 counties as rural, leverages providers in neighboring states to provide telehealth services. As a result, they’ve invested in creating online provider resources that include webinars, resource guides, and regular provider communications in a provider portal.
Does Medicaid Reimburse Telehealth Services?
It depends on the state, but the general answer is yes. Because each state has relatively broad powers to determine coverage, the federal government has not set a telehealth reimbursement standard. However, a recent KFF survey of state Medicaid administrators found that all states that responded to their survey cover some type of telehealth service. For example, telehealth coverage for well/sick child visits was covered in all but one state that answered the survey. All but one state covered mental health. 20% of states failed to cover dental services.
What Impact will COVID-19 Have on Future Medicaid Telehealth Reimbursement?
COVID-19 likely will or has spurred states to expand telehealth coverage within their Medicaid program. The KFF Medicaid survey cited earlier indicates that 11 states indicated they plan to change telehealth reimbursement policies in 2022. It also noted that many states anecdotally found that both members and providers viewed expanded telehealth positively and that it decreased barriers to care. That positivity may lead to increased demand for access to telehealth services.
Certifi helps states with Section 1115 Medicaid waivers or Medicaid buy-in programs bill and collect payments thanks to a premium billing and collections module that is R3 certified for Medicaid.