It may seem like whenever telehealth comes up, questions about reimbursement are just around the corner.
And that's to be expected. While there have been some recent strides forward on the telehealth reimbursement landscape, it can still be a tricky topic to understand. Particularly with Medicaid.
As state-specific programs, Medicaid programs vary from state-to-state on what guidelines physicians have to follow to get reimbursed for telehealth. While almost all state Medicaid programs offer some sort of coverage for live video telemedicine, the exact medical services and use cases they'll reimburse for range widely.
Well, you might be wondering, what about my state? How does Medicaid reimburse for telehealth services in my home state? Can I use telehealth with my patients?
Let's break it down.
Medicaid Coverage for Live Telemedicine
To make things simple, we're focusing specifically on live telemedicine (think videochat) for now. If you'd like to learn more about how Medicaid covers store-and-forward or remote patient monitoring, check out our Medicaid page.
9 states and the District of Columbia have laws specifically mandating coverage for live telemedicine services under their Medicaid programs:
- District of Columbia
While many other states don't have state laws requiring Medicaid coverage of telehealth, almost all states (except Connecticut and Rhode Island) have some form of coverage for live telemedicine within their Medicaid programs. They just don't mandate it at the state level.
Types of Healthcare Providers Allowed to Bill Medicaid for Telehealth
Many Medicaid programs will specify which healthcare providers can bill for telehealth. So even if you're in a state that mandates Medicaid coverage of telehealth, you need to make sure you're following the guidelines on which healthcare providers can offer telehealth (and get paid for it).
The good news is - sixteen states and D.C. have no restrictions on which healthcare providers are allowed to bill for telemedicine through their state Medicaid programs. Here's the list:
- North Dakota
- South Dakota
- New Mexico
- New Hampshire
If your state isn't on that list, it means your Medicaid program has a specific list of healthcare providers who can bill for telehealth. You'll need to check your manual, or find your state here, for the details. Note that if you're located in Florida, Idaho, or Montana, Medicaid only covers telehealth services practiced by physicians.
Patient Location at the Time of the Visit
While the beauty of telehealth is that patients can get treatment from anywhere with an internet connection, some Medicaid programs haven't caught up with this idea. The old telemedicine model, which Medicare and many Medicaid programs are still based on, required rural or remote patients to travel to a local health clinic to do telehealth appointments with a far-away specialist.
This means some Medicaid programs require the patient to be at a specific location, sometimes called "eligible originating site," at the time of the telehealth visit. However many states have eliminated this outdated restriction and allow patients to do telehealth from their homes. Currently, 36 states recognize the patient's home as an eligible originating site:
Don't see your state on this list? That means your state Medicaid program probably has a specific list of locations where a patient has to be at the time of the telehealth service, an their home is not on there. To find out more, find your state on this map.
Still have questions about how Medicaid reimbursement for telehealth services works in your state? Find your state page here, or check out additional resources at: