Uneven Access: How Rurality and State Policies Shaped Telehealth Provision to Medicaid Enrollees, 2020–2021

OBJECTIVE: This study assesses how providers delivered telehealth services to pregnant Medicaid enrollees, using multistate Medicaid claims data. It also examines how provider rurality and state-level telehealth policies influenced provision. METHODS: We analyzed claims data on telehealth provision from the Transformed Medicaid Statistical Information System Technical Analytic File from January 2020 to April 2021. Monthly telehealth provision was estimated for family physicians, obstetricians and gynecologists, nurse practitioners, and physician associates, and variations therein were examined by rurality and state policy. RESULTS: Telehealth provision peaked in April 2020, when 19.5% of providers delivered at least one telehealth service. At the peak in April 2020, rural providers were less likely to provide telehealth than urban providers (15.2% vs. 20.6%), and states with telehealth-supportive policies saw higher provision of telehealth by providers (20.9%) than those without (14.3%). Throughout the study period, rural providers from all specialties in nonsupportive policy states showed the lowest telehealth provision. CONCLUSIONS: Provider location rurality and state policy environments significantly influenced telehealth provision. Sustained policy support is essential to ensure equitable access to perinatal care.