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.
