State Medicaid and private telemedicine coverage requirements and telemedicine use, 2013–2019

Abstract

Objective: To examine the association between state Medicaid and private telemedicine coverage requirements and telemedicine use. A secondary objective was to examine whether these policies were associated with health care access. Data Sources and Study Setting: We used nationally representative survey data from the 2013–2019 Association of American Medical Colleges Consumer Survey of Health Care Access. The sample included Medicaid-enrolled (4492) and privately insured (15,581) adults under age 65. Study Design: The study design was a quasi-experimental two-way-fixed-effects difference-in-differences analysis that took advantage of state-level changes in telemedicine coverage requirements during the study period. Separate analyses were conducted for the Medicaid and private requirements. The primary outcome was the past-year use of live video communication. Secondary outcomes included same-day appointment, always able to get needed care, and having enough options for where to go to receive care. Data Collection/Extraction Methods: N/A. Principal Findings: Medicaid telemedicine coverage requirements were associated with a 6.01 percentage-point increase in the use of live video communication (95% CI, 1.62 to 10.41) and an 11.12 percentage-point increase in always being able to access needed care (95% CI, 3.34 to 18.90). While generally robust to various sensitivity analyses, these findings were somewhat sensitive to included study years. Private coverage requirements were not significantly associated with any of the outcomes considered. Conclusions: Medicaid telemedicine coverage during 2013–2019 was associated with significant and meaningful increases in telemedicine use and health care access. We did not detect any significant associations for private telemedicine coverage policies. Many states added or expanded telemedicine coverage policies during the COVID-19 pandemic, but states will face decisions about whether to maintain these enhanced policies now that the public health emergency is ending. Understanding the role of state policies in promoting telemedicine use may help inform policymaking efforts going forward.