Virtual doctor visits are convenient as they allow patients to receive medical care from the comfort of their homes. These visits limit the spread of infectious diseases and expand access to medical services for people living far from medical facilities. Medicaid expanded its coverage for telehealth services, and it can cover your doctor’s virtual visits. Here’s more on whether Medicaid can cover your online doctor visit.
Understanding Medicaid
Medicaid is a public health insurance program that helps low-income households access quality medical care. Federal law requires states to provide the following services in their Medicaid programs:
- Inpatient and outpatient doctor consultations
- Laboratory services
- Home health services
- X-ray services
Since states administer the program, they can determine the services that fall within Medicaid’s coverage but don’t exclude the above-mentioned mandatory services. Online doctor visits are optional services, so their Medicaid coverage differs from state to state.
Varieties of Online Doctor Visits
There are various types of online doctor visits since different states have their own regulations. Virtual doctor visits can fall into any of three categories—live conferencing, remote patient monitoring, and store-and-forward.
Live conferencing involves real-time audio and visual patient assessments. You and your doctor should be logged into your chosen communication platform at the same time.
Remote patient monitoring involves the assessment of previously recorded patient information. This may include evaluating a patient’s blood pressure, vital signs, and weight.
Store-and-forward is the electronic transmission of patient information to a specialist who uses the data to offer treatment outside of real-time interaction. Specialties that can fall within the store-and-forward class include radiology, dermatology, oncology, and orthopedics.
Medicaid and Live Conferencing
While Many states offer some form of live conferencing reimbursement in their Medicaid programs, they follow varying rules and restrictions. Your state may restrict its Medicaid live conferencing reimbursement to specific specialties and providers or limit your location to specific originating sites.
For example, New Jersey’s Medicaid program only covers telepsychiatry live conferencing services. The state also imposes restrictions on originating sites — you’ll only be reimbursed after receiving the services from your home if your doctor is an independent practitioner.
Other states, like Arkansas and Hawaii, are less restrictive and allow Medicaid to cover services it would cover in regular in-person consultations. Research your state’s rules before seeking telehealth services to confirm whether Medicaid will reimburse you.
Medicaid and Remote Patient Monitoring
Roughly half the states in the US reimburse for remote patient monitoring. These states impose restrictions like:
- Limiting the type of conditions your doctor can monitor remotely
- Restricting providers who can offer the service
- Determining the kind of information that medical professionals can monitor
- Limiting the devices medical professionals can use to monitor patients
Kansas’ Medicaid program reimburses for remote patient monitoring if it’s prescribed by a licensed medical practitioner, offered by a licensed practical nurse or registered nurse, deemed necessary, and authorized by the program’s beneficiary.
Alabama limits the conditions doctors can monitor remotely to congestive heart failure, diabetes, and hypertension. You need to read through your state’s Medicaid program rules to determine if they’ll reimburse you for remote monitoring.
Medicaid and Store-and-Forward
Store-and-forward visits are less commonly reimbursed than live conferencing and remote patient monitoring. Most states stipulate that virtual doctor visits have to be real-time, thus eliminating store-and-forward visits from coverage.
States like Alaska, Kentucky, Georgia, New York, West Virginia, Missouri, Texas, and Oregon reimburse store-and-forward visits. Some limit their Medicaid programs to specific conditions and technology. For example, Oregon only allows teledentistry in the store-and-forward form.
Book an Online Doctor Visit
You can schedule an online doctor visit if you can’t leave your home or want to enjoy the convenience of virtual treatment. Different states’ Medicaid programs cover varying aspects of telehealth and impose different restrictions. Research your state’s Medicaid regulations to determine if your virtual doctor visits are covered.
