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Interstate Telehealth Policy and Provider Incentives: Recommendations to Combat Historically Low Physician Acceptance of Medicaid Patients

Telehealth and Medicine Today (TMT)

By Telehealth and Medicine Today (TMT)

Telehealth and Medicine Today (TMT) is a leading international peer review journal where multidisciplinary thought leaders, practitioners, and stakeholders converge to address strategic, medical, technical, economic, legal, regulatory and societal aspects of this growing health technology sector.

Sophia S. Albanese, Emily A. Yin, Sarah J. Timmons

Methods: A holistic, mixed-methods approach is used to investigate the research goal. Primary source telehealth reimbursement data obtained from the Medicaid offices of Florida and Nebraska, extensive literature review on Medicaid and telehealth policy, as well as secondary source data from online databases and previously published research were used to highlight the improvements needed to better implement telehealth programs across the country, as well as identifying precedential cases of policy changes regarding telemedicine.

Results: The primary and secondary source data analyzed in this article demonstrate the need for policy changes to address historically low physician acceptance of new patients through state Medicaid. Data obtained from Florida and Nebraska in Table 1 corroborate with the data in

Table 2 – both demonstrating how Florida reimburses at a much lower rate (0.79 to national Medicaid average) as compared to Nebraska (1.14 to national Medicaid average). Table 3 exhibits how national averages for Medicaid reimbursement, as well as Florida’s and Nebraska’s averages, fall below the national averages for Medicare reimbursement in all categories except obstetric care, showing that Medicaid services are reimbursed at a lower rate than Medicare in most circumstances.

Conclusions: Nationally, Medicaid reimbursement rates are among the lowest reimbursement rates of any insurer. Additionally, new Medicaid patients witness the lowest rates of acceptance by physicians, in large part due to low reimbursement rates. Medicaid policies and reimbursement rates vary across each state, making it difficult to enact any broad-sweeping policies to improve the access to care for Medicaid beneficiaries in the United States. However, by drawing reference to several policy changes involving Medicare, Medicaid, and telehealth, this paper presents recommendations for an incentivized cross-state telehealth policy aimed toward increasing Medicaid beneficiaries’ access to care. With nation-wide policy changes like those during the COVID-19 pandemic, there are historical examples and precedence to support policies focused on decreasing the limitations and barriers needed to practice telemedicine across state lines. This paper offers a potential, but limited framework for states to consider implementing in their Medicaid programs after conducting further research on the state-by-state level.

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