Medicaid beneficiaries are less likely to use telehealth to access substance use disorder care than their counterparts enrolled in Medicare Advantage or commercial insurance.
According to new research published in JAMA, Medicaid beneficiaries represent 93.2% of all substance use disorder treatment visits, yet they account for only 75% of telehealth services for SUD treatments.
Meanwhile, commercially insured patients account for 6.4% of overall SUD treatments, but 24% of telehealth SUD treatments.
Telehealth usage for SUD care rose for rural populations. Researchers found that rural patients make up for 8.1% of all SUD telehealth visits and 6.4% of all SUD treatment visits.
“Medicaid-covered individuals were underrepresented within telehealth SUDT utilization, with overall [substance use disorder treatment] SUDT declining,” authors of the study wrote. “This finding raises equity concerns for Medicaid populations. For rural individuals, telehealth may be reducing disparities, with overall SUDT increasing throughout the [public health emergency] to a greater extent than for urban individuals.”
The fate of telehealth in SUD care has hung in the balance for years, particularly for controlled substance prescribing, often used to treat opioid use disorders.
During the COVID-19 pandemic, The U.S. Drug Enforcement Administration (DEA) granted telehealth prescribers flexibilities, including the ability to prescribe medication-assisted-treatment drugs virtually without the need for an in-person visit. During this time, telehealth for SUD care became increasingly popular.
In 2023, the agency released a proposal that would mostly end all virtual controlled substance prescribing without an in-person visit. This was met with so much opposition from the SUD industry that the agency extended the flexibilities to give it time to consider “a new path forward for telemedicine.”
The flexibilities have now been extended three times, the last time extending the flexibilities through 2025.
In January, the DEA and Department of Health and Human Services announced a new final rule that allows clinicians to prescribe buprenorphine via telehealth or audio-only telehealth for up to six months.
The agency also released a proposed rule allowing certain practitioners to prescribe controlled substances virtually as long as they met the requirements of a special registration framework. The Trump administration withdrew the special registration rule soon after the administration change. While it does not necessarily mean the rule is dead, it is currently on pause.
