The COVID-19 state of emergency upended years of restrictive telehealth regulations in Maryland’s Medicaid program, which provides health coverage to low-income or disabled children and adults.
In March, Maryland temporarily expanded access to virtual health care provided via phone or video app for Medicaid beneficiaries. Telehealth delivered in patients’ homes makes clinical care accessible while reducing the risk of exposure to the novel coronavirus.
Although Maryland’s hospitals and medical practices quickly pivoted to providing thousands of telehealth appointments per day, the Maryland Department of Health recently announced that expanded telehealth benefits for Medical Assistance will end on July 25th. Not only are we still in the middle of the COVID-19 pandemic, but health care remains as inaccessible as ever for Maryland Medicaid beneficiaries.
At baseline, Medicaid patients face greater barriers to high quality health care than patients with other types of health insurance. Whether due to systemic racism, transportation issues, or just a tougher time missing work or finding child care for an appointment, Medicaid beneficiaries are vulnerable — even more so in times of crisis.
In the eventual aftermath of this pandemic, our health care system will struggle back to its feet, but access challenges for Medicaid patients will persist and may even worsen. Although it is too early to know the impact of potential care delays, anecdotes suggest that many serious health conditions will continue to go unchecked over the coming months. Medicaid patients lack a cushion, financially as well as clinically, to allow their conditions to worsen.
Under state Medicaid regulations, telehealth is subject to strict requirements. The patient needs to have been seen in the physician’s practice within the last three years. The visit must be conducted through an interactive, audiovisual platform instead of a phone call. And, outside the state of emergency, the visit must take place at a qualified “originating site” such as a clinic or hospital instead of a patient’s own home.
Until recently, telehealth was considered a convenient luxury. But as “social distancing” became the norm, the ability to get care virtually rapidly evolved into a public health necessity. In the private sector, telehealth companies such as American Well and Teladoc have been providing convenient from-home virtual care for years, but these video visits come with a price tag most Medicaid beneficiaries cannot afford. To be sure, telehealth regulations exist for a reason. From protecting data privacy, assuaging system fraud, and ensuring high quality care, these regulations safeguard against several potential risks. But the barriers to care that Medicaid patients face do not go away once COVID-19 does.
July 25 is too soon to roll back these important telehealth benefits. The statewide positivity rate for coronavirus tests is now under 5%, but new cases still exceed 400 per day, and over 3,000 Marylanders have died with COVID-19 so far this year. Public health experts expect a second and even third wave of the pandemic to hit as movement restrictions are lifted across the country.
At some point, however, this pandemic will end, and the Maryland Department of Health will have a unique opportunity. By overhauling the state’s Medicaid telehealth laws, Maryland will emerge at the vanguard of states committed to keeping all its residents safe.
Allowing telehealth visits from home or work as originating sites; to treat both acute and chronic conditions; and for new as well as established patients will dramatically improve access to care in the post-COVID-19 era. Taking bold legislative action will provide the much-needed hope that, eventually, things will get better for the most vulnerable Marylanders.
As a physician practicing in Southwest Baltimore and a Baltimore-based health IT policy specialist, we look forward to the day when Medicaid beneficiaries taking off work, arranging child care, and taking three buses just to see their doctor becomes — like COVID-19 — a sad and distant relic of the past. We call on state lawmakers and the Maryland Department of Health to take up these reforms for the benefit of all Marylanders.
Lisa Bari (email@example.com) is a health IT policy specialist and the former health IT and interoperability lead for the Centers for Medicare and Medicaid Services’ Innovation Center. Dr. Alan L. Kaplan (firstname.lastname@example.org) is a practicing urologist in Baltimore, and a board member of HealthCare Access Maryland.