Nearly 1 in 5 Medicaid enrollees depend on telehealth to access care

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About one in three adults enrolled in Michigan’s Medicaid expansion program used telehealth last year — and nearly two-thirds said they wouldn’t have received care otherwise, according to a new University of Michigan study.

The research, published in Health Affairs Scholar, draws on data from more than 4,000 enrollees in the Healthy Michigan Plan and provides one of the most detailed looks to date at how low-income patients use and experience telehealth. The study’s findings arrive as federal lawmakers prepare to decide whether to continue expanded Medicare and Medicaid telehealth coverage introduced during the COVID-19 pandemic.

“Telehealth has become much more common in American health care, but data has been scarce on its use by Medicaid enrollees, who have low incomes and many potential barriers to care such as transportation, getting time off work and caregiving responsibilities,” said Terrence Liu, MD, MS, lead author of the study and a clinical instructor at the University of Michigan Medical School.

The survey found that 63.3% of telehealth users said the visit “helped provide care that they could not or would not otherwise receive.” Of all users, 92.1% reported that their physician adequately addressed their health concerns during their call.

Patients with barriers used it more

Enrollees who reported difficulty accessing in-person care were significantly more likely to utilize telehealth. Among patients with a primary care physician (PCP) who also reported barriers — such as trouble scheduling appointments or delays in communication — 43% used telehealth. That compared to 32.8% of those with a PCP but not access barriers. Only 18.7% of those without a regular PCP reported using telehealth.

The Healthy Michigan Plan serves more than 725,000 adults ages 18 to 64 with incomes up to 133% of the federal poverty level. The survey was part of the state’s official evaluation of the program, which is conducted in partnership with the Michigan Department of Health and Human Services (MDHHS) and required by the Centers for Medicare & Medicaid Services (CMS).

Digital access remains uneven

While most telehealth visits were conducted via video (66.3%), digital barriers were common. A quarter of telehealth users reported being uncomfortable using the internet for health care, and 12% said they lacked reliable internet access. Twenty-one percent of users didn’t have a patient portal account.

Still, satisfaction remained high regardless of modality. Even among those using phone-based care or with low digital confidence, most said their needs were met.

The study also noted disparities in who accessed telehealth. White, non-Hispanic patients accounted for 67% of all telehealth users. By contrast, just 16% of users were Black, 6% were Hispanic, and 4% were Arab, Chaldean or Middle Eastern. The authors did not speculate on causes but noted that the gap warrants further study.

Women used telehealth more than men (38.4% vs. 29.3%), and younger adults were more likely to have video visits. Rural users were more likely than urban or suburban residents to use video rather than audio-only formats, suggesting that telehealth may be bridging geographic barriers in care delivery.

Policy

“As policymakers continue to debate the permanency of the many telehealth flexibilities that were expanded during the COVID-19 Public Health Emergency,” the authors wrote, “our findings can inform these discussions by providing important perspectives from Medicaid enrollees.”

The telehealth flexibilities are currently set to expire at the end of 2025 unless extended by Congress.

Although national telehealth use has declined from its peak during the pandemic, researchers noted that use remains above pre-pandemic levels and may become a lasting part of health care delivery — particularly for patients who otherwise go without care.