Interstate telehealth use by Medicare beneficiaries before and after COVID-19 license waivers, 2017-2020

During the COVID-19 pandemic, all fifty states and Washington, D.C., enacted license waivers that allowed patients to participate in telehealth visits with out-of-state clinicians (i.e. say interstate telehealth). Since many of these temporary flexibilities have expired or are about to expire, we analyzed trends in telehealth use across states by Medicare beneficiaries over the 2017-2020 period, which covers the period both directly before and during the first year of the pandemic. Although the volume of interstate telehealth usage increased in 2020, out-of-state telehealth accounted for a small share of all outpatient visits (0.8%) and all telehealth visits (5%) in all. For individual states, out-of-state telehealth accounted for between 0.2% and 9.3% of all outpatient visits. We found that most out-of-state telehealth use was for established patient care and that a higher percentage of out-of-state telehealth users lived in rural areas compared to recipients who did not receive care outside their state (28% vs. 23%). percent). Our collective findings suggest that the elimination of pandemic licensure flexibilities will affect different states to varying degrees and will also affect the delivery of care for established patients and rural patients.

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