Interstate Telehealth Policy and Provider Incentives: Recommendations to Combat Historically Low Physician Acceptance of Medicaid Patients

Abstract

Methods

A holistic, mixed-methods approach was used to investigate the research goal. Primary source telehealth reimbursement data obtained from the Medicaid offices of Florida and Nebraska, extensive literature review on Medicaid and telehealth policy, as well as secondary source data from online databases and previously published research were used to highlight the improvements needed to better implement telehealth programs across the country, as well as to identify precedential cases of policy changes regarding telemedicine.

Results

The primary and secondary source data analyzed in this article demonstrate the need for policy changes to address historically low physician acceptance of new patients through state Medicaid. Data obtained from Florida and Nebraska in Table 1 corroborate with the data in Table 2—both demonstrating how Florida reimburses at a much lower rate (0.79 to national Medicaid average) as compared to Nebraska (1.14 to national Medicaid average). Table 3 exhibits how national averages for Medicaid reimbursement, as well as Florida’s and Nebraska’s averages, fall below the national averages for Medicare reimbursement in all categories except for obstetric care, showing that Medicaid services are reimbursed at a lower rate than Medicare in most circumstances.

Table 1

Comparing reimbursement rates for nine telemedicine codes in Florida and Nebraska

Medicaid Fee-for-Service Reimbursement Rates for Telemedicine Services, 2017–2018
Procedure code	Florida Medicaid ($)	Nebraska Medicaid($)	% difference
90791	76.18	179.32	135.39
90792	64.79	250.77	287.05
99211	2.13	32.18	1,410.8
99213	29.02	64.45	122.09
99214	50.33	88.80	76.44
99252	43.19	65.68	52.07
99253	66.14	94.30	42.58
99254	95.00	110.70	16.53
99255	114.33	126.28	10.45

Source: Office of Public Records at the Agency for Health Care Administration for the State of Florida; Public Records Department for the Health and Human Services Department for the State of Nebraska.

Table 2

Comparing state and national reimbursement rates under Medicaid fee-for-service. ⁹

Medicaid Physician Fee Index, 2016	United States	Florida	Nebraska
All services	1	0.79	1.14
Primary care	1	0.74	1.02
Obstetric care	1	1.05	1.14
Other services	1	0.75	1.45

Table 3

Comparing Medicaid fee-for-service reimbursement rates with Medicare fee-for-service reimbursement rates. ⁹

Medicaid-to-Medicare Fee Index, 2016	United States	Florida	Nebraska
All services	0.72	0.56	0.92
Primary care	0.66	0.48	0.71
Primary care for physicians eligible for increased fee	null	0.53	1.01
Obstetric care	0.81	0.82	1.05
Other services	0.82	0.58	1.33

Conclusions

Nationally, Medicaid reimbursement rates are among the lowest reimbursement rates of any insurer. Additionally, new Medicaid patients witness the lowest rates of acceptance by physicians, in large part due to low reimbursement rates. Medicaid policies and reimbursement rates vary across each state, making it difficult to enact any broad-sweeping policies to improve the access to care for Medicaid beneficiaries in the United States. However, by drawing reference to several policy changes involving Medicare, Medicaid, and telehealth, this article presents recommendations for an incentivized cross-state telehealth policy aimed at increasing Medicaid beneficiaries’ access to care. With nation-wide policy changes like those during the COVID-19 pandemic, there are historical examples and precedence to support policies focused on decreasing the limitations and barriers needed to practice telemedicine across state lines. This article offers a potential, but limited framework for states to consider implementing in their Medicaid programs after conducting further research on the state-by-state level.