Expanding Telehealth Under COVID-19: Supporting Access to Care

Expanding Telehealth Under COVID-19: Supporting Access to Care

Telehealth is an increasingly important tool for states to address patient needs under COVID-19 social distancing requirements. Federal COVID-19 Medicaid guidance encourages states to offer telehealth to help meet service needs during the pandemic. These efforts come at a time when most people in the United States are unfamiliar with telehealth but willing to try virtual care. While telehealth should help provide more ways to access ongoing care, there are additional barriers for some because of unequal access to the technology. Before relying on telehealth to help meet health care needs, state Medicaid agencies should ensure it is available for all people in a state. This must take into consideration differing access to technology and the accessibility of the telehealth methods.

Using Medicaid to Go Beyond Authorizing Telehealth

Medicaid agencies are using emergency authorities, such as 1135 waivers, state plan amendments, Appendix K amendments, and other mechanisms, to allow telehealth to be used and to otherwise support the use of telehealth. Most states are simply using these changes to allow telehealth for a variety of services, as long as providing the service through telehealth will meet the person’s needs. Whether or not telehealth is appropriate may depend on the service, the individual’s access to technology, and the person’s ability to use the telehealth method.

Technological Access Barriers

Widespread access to telehealth is limited by a handful of potential barriers. These barriers include having reliable access to high-speed internet, and the cost of purchasing devices for video conferencing or equipment to monitor health status. For example, even though more than  96 percent of people in the U.S. own a cellphone, fewer people own smartphones and ownership varies greatly by age, race, education level, geographic area, and income. This implies that some smartphone features used for telehealth, like video conferencing or web apps, may be less useful as evaluation and treatment tools than others without additional support and investment.

Some states used the Appendix K authority to go beyond simply allowing the use of telehealth:

  • Kansas provides participants with chronic diseases telehealth monitoring equipment to help them manage their conditions so medical intervention happens before health problems deteriorate. Participants are trained on how to use the equipment and will have control over when monitoring takes place. The telehealth services provided includes cardiac and vital sign telemonitoring with phone consultations, web applications, and phone apps.
  • New Mexico offers participants up to $500 to ensure they have access to a computer, tablet, or other smart device necessary for remote video conferencing, training, and monitoring by clinicians.

Technology Alone Is Not Enough

Merely permitting telehealth or even providing technology does not mean that everyone will be able to access telehealth. The person must also have sufficient ability or comfort with technology–both software and hardware.  This ability, known as digital literacy, impacts access to and benefits from telehealth. In addition, people with disabilities may face additional barriers with telehealth technology. Using telehealth could increase access to care for people with disabilities, but the telehealth technology must be properly matched to the individual’s functional or cognitive needs. Without addressing digital literacy and access to technology, a move toward increased telehealth may increase health disparities, especially when, like now, physical access to care is more limited.

Efforts to provide telehealth devices, like those in New Mexico, may improve access to technology and may help remove some of these barriers to telehealth that disproportionately impact low-income and underserved populations. In a time when health care systems in many localities are stressed to capacity, telehealth offers a way to address health care needs without exposing people and their providers to potential harm. But only if everyone can both access the necessary devices and technology and understand how to use the technology.


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