Telehealth’s Vital Role in Medicaid
As healthcare evolves in the post -COVID era , telehealth has emerged as a critical lifeline for millions of Americans , particularly those enrolled in Medicaid . A groundbreaking study from the University of Michigan , published on April 16, 2025, in Health Affairs Scholar , reveals that nearly one in three adults in Michigan’s Medicaid expansion program , the Healthy Michigan Plan, utilized telehealth services last year . Strikingly , 63.3% of these users reported that telehealth provided care they otherwise could not or would not have accessed . With federal lawmakers poised to decide the fate of expanded telehealth coverage for Medicare and Medicaid by the end of 2025, these findings underscore the stakes for low-income patients and the broader healthcare system .
Telehealth’s Rise in Medicaid
The COVID-19 pandemic catalyzed a seismic shift in healthcare delivery , with telehealth transitioning from a niche service to a mainstream necessity . Temporary flexibilities introduced during the public health emergency allowed Medicaid and Medicare to expand telehealth coverage , enabling patients to access care remotely via video or phone . While national telehealth use has declined from its pandemic peak , it remains significantly higher than pre -COVID levels , particularly for vulnerable populations .
The University of Michigan study , led by Dr. Terrence Liu , offers one of the most comprehensive examinations of telehealth use among Medicaid enrollees . Drawing on survey data from over 4,000 participants in the Healthy Michigan Plan, which serves more than 725,000 adults with incomes up to 133% of the federal poverty level , the study highlights telehealth’s transformative impact . About 33% of enrollees used telehealth in the past year , with 92.1% reporting that their health concerns were adequately addressed during these visits . This high satisfaction rate underscores telehealth’s potential to deliver quality care , even for complex populations .
Bridging Barriers to Care
Medicaid enrollees often face significant barriers to in-person care , including transportation challenges , inflexible work schedules , and caregiving responsibilities . The Michigan study found that patients reporting such barriers were far more likely to use telehealth . Among those with a primary care physician (PCP) who also faced access issues — like difficulty scheduling appointments or delays in communication —43% utilized telehealth , compared to 32.8% of those with a PCP but no barriers . Only 18.7% of enrollees without a regular PCP reported using telehealth , suggesting that established provider relationships may facilitate virtual care adoption .
Telehealth’s ability to overcome geographic barriers is particularly notable . Rural enrollees were more likely to use video-based telehealth than their urban or suburban counterparts , indicating that virtual care is helping bridge gaps in healthcare access for underserved areas . This is critical in states like Michigan , where rural communities often face shortages of healthcare providers .
The study also revealed that telehealth is serving as a lifeline for patients who might otherwise forgo care . Nearly two-thirds of users (63.3%) said their telehealth visit provided care they could not have accessed otherwise , whether due to logistical barriers or lack of available in-person services . This finding highlights telehealth’s role in ensuring continuity of care for low-income populations , who are disproportionately affected by healthcare disparities .
Digital Divide and Disparities
Despite its benefits , telehealth adoption is not without challenges . Digital access remains a significant hurdle for some Medicaid enrollees . The study found that 25% of telehealth users were uncomfortable using the internet for healthcare , 12% lacked reliable internet access , and 21% did not have a patient portal account . These barriers disproportionately affect certain groups , potentially exacerbating existing inequities .
Demographic disparities in telehealth use were also evident . White, non-Hispanic enrollees accounted for 67% of telehealth users , while Black patients made up 16%, Hispanic patients 6%, and Arab , Chaldean , or Middle Eastern patients 4%. Women were more likely to use telehealth than men (38.4% vs . 29.3%), and younger adults were more inclined to opt for video visits . The study’s authors did not speculate on the causes of these disparities but emphasized the need for further research to understand and address them .
While video visits dominated (66.3% of telehealth interactions ), audio-only visits remained common , particularly for those with limited digital access or confidence . Notably , satisfaction levels were high across both modalities , suggesting that even simpler phone-based care can effectively meet patients ’ needs . This flexibility is crucial for ensuring equitable access to telehealth , especially for enrollees with technological or economic constraints .
Policy Implications
The Michigan study arrives at a pivotal moment , as Congress debates whether to extend the telehealth flexibilities set to expire at the end of 2025. These flexibilities , introduced during the COVID-19 public health emergency , expanded coverage for virtual care , relaxed provider licensing requirements , and allowed reimbursement for a broader range of telehealth services . Without legislative action , millions of Medicaid enrollees could lose access to virtual care , potentially disrupting their ability to manage chronic conditions , access mental health services , or receive timely consultations .
The study’s findings offer critical insights for policymakers . Telehealth’s role in addressing barriers to care — particularly for low-income patients with logistical or geographic challenges — suggests that permanent coverage could significantly improve health outcomes and reduce disparities . The high satisfaction rates and ability to deliver care that would otherwise be inaccessible further bolster the case for maintaining these flexibilities .
However , policymakers must also address the digital divide . Investments in broadband infrastructure , patient education , and user-friendly telehealth platforms could help close gaps in access and ensure that all enrollees can benefit from virtual care . Additionally , addressing demographic disparities in telehealth use will require targeted outreach and culturally competent strategies to engage underrepresented groups .
The Broader Context
The Michigan findings reflect broader trends in healthcare delivery . Telehealth has become a lasting component of the U.S. healthcare system , with implications for providers , payers , and patients . For Medicaid programs , virtual care offers a cost-effective way to expand access and manage population health , particularly for chronic conditions that require ongoing monitoring . A 2023 report from the Kaiser Family Foundation estimated that telehealth could reduce Medicaid costs by up to 10% for certain services by decreasing emergency room visits and hospitalizations .
Yet , the future of telehealth in Medicaid is uncertain . The Centers for Medicare & Medicaid Services (CMS), which oversees the Healthy Michigan Plan evaluation , requires states to demonstrate that their Medicaid programs are effective and sustainable . The Michigan study , conducted in partnership with the Michigan Department of Health and Human Services (MDHHS), provides evidence of telehealth’s value , but ongoing scrutiny of program costs and outcomes could influence future policy decisions .
The debate over telehealth also intersects with broader discussions about healthcare equity . Medicaid enrollees , who often face socioeconomic challenges , stand to benefit disproportionately from virtual care . However , without sustained investment and policy support , these benefits could be undermined , leaving vulnerable populations at risk .
Challenges and Opportunities
While the Michigan study paints an optimistic picture of telehealth’s impact , it also highlights areas for improvement . The digital divide remains a significant barrier , particularly for enrollees with limited internet access or technological literacy . States and providers must work together to provide resources , such as subsidized devices or telehealth training , to ensure equitable access .
Disparities in telehealth use by race , ethnicity , and gender also warrant attention . Community- based interventions , such as partnerships with local organizations or targeted outreach campaigns , could help increase adoption among underrepresented groups . Additionally , providers should prioritize culturally sensitive care delivery to build trust and engagement .
On the policy front , extending telehealth flexibilities will require balancing cost concerns with the need to expand access . Lawmakers may face pressure from healthcare providers and patient advocates to make coverage permanent , but fiscal conservatives could argue for stricter oversight or limited reimbursement . The Michigan study’s evidence of telehealth’s effectiveness could tip the scales in favor of extension , but political dynamics will play a significant role .
The University of Michigan’s study on telehealth use in the Healthy Michigan Plan offers a compelling case for the continued expansion of virtual care in Medicaid . By addressing barriers to in-person care and delivering services that would otherwise be inaccessible , telehealth is transforming the healthcare landscape for low-income Americans . With nearly one in three enrollees relying on telehealth and two-thirds citing it as essential , the stakes are high as Congress considers the future of coverage .
As policymakers weigh their options , they must prioritize solutions that bridge the digital divide , address disparities , and ensure that telehealth remains a viable option for Medicaid enrollees . The Michigan experience demonstrates that virtual care is not just a temporary fix but a vital tool for building a more equitable and accessible healthcare system . Whether telehealth becomes a permanent fixture in Medicaid will depend on the actions taken in the coming months , but the evidence is clear : for millions of low-income patients , it’s a lifeline worth preserving .