The Center for Connected Health Policy (CCHP) has a Telehealth Policy Finder where you can look up all telehealth-related policies and regulations, including those related to Private Payer and Medicaid Reimbursement across all 50 states and the District of Columbia, as well as at the federal level.
CCHP has also put together the following resources to help you compare and contrast the laws and reimbursement policies for each state, including those related to Private Payer and Medicaid Reimbursement.
- Bi-Annual State Telehealth Laws and Reimbursement Policies Report
- Online State Telehealth Policy Comparison Tool
- State Policy Trend Maps
- State Medicaid & CHIP Telehealth Toolkit - February 2024
Private Payer Reimbursement. CCHP has created this video discussing how private payer telehealth laws works:
Most of the states in the MATRC region have some form of private (commercial) payer parity laws related to telehealth. There are two types of parity laws. One is referred to as coverage or ‘service parity’. Service parity means that commercial health plans may not deny reimbursement for a covered service solely because it was provided via telehealth. This type of parity does not guarantee the same rate of payment. The other type of parity is ‘payment parity’. This requires commercial health plans to reimburse for telehealth services at the same rate as in-person care. These laws generally do not apply to self-insured plans.
- View Parity Laws by State
- 50-State Survey of Telehealth Insurance Laws (this is a free resource developed by Foley & Lardner, LLP, however it does require the user to register to access the file download)
Medicaid Reimbursement. States have broad discretion in designing their approaches to telehealth since telehealth is a delivery method, not a benefit type. Telehealth is viewed as an alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient). As such, states have the option/flexibility to determine whether (or not) to cover telehealth; what types of telehealth to cover; where in the state it can be covered; how it is provided/covered; what types of telehealth practitioners/providers may be covered/reimbursed, as long as such practitioners/providers are "recognized" and qualified according to Medicaid statute/regulation; and how much to reimburse for services delivered using telehealth, as long as such payments do not exceed Federal Upper Limits.
- For more information about what State Medicaid programs are able to do from a statutory or regulatory perspective, CMS has developed the following guidance documents:
- Medicaid & CHIP Telehealth Toolkit
- Medicaid & CHIP Telehealth Toolkit Supplement #1
- Medicaid & CHIP Telehealth Toolkit Checklist for States
- Medicaid State Plan Fee-for-Service Payments for Services Delivered Via Telehealth
- Rural Health Care and Medicaid Telehealth Flexibilities, and Guidance Regarding Section 1009 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act
- Coverage and Payment of Interprofessional Consultation in Medicaid and Children's Health Insurance Program (CHIP)
- All fifty states and the District of Columbia have some form of Medicaid reimbursement for telehealth. No two state Medicaid policies are identical in their requirements and restrictions! CCHP has created this video discussing how Medicaid telehealth policy works:
- For more information about the specific Medicaid Policies found in one or more of the MATRC states, visit Telehealth In My State and then select your state of interest where you will find a section on Medicaid.
Frequently Asked Questions About Medicaid and Telehealth:
- Is it true that for outpatient mental health clinics, Medicaid requires either the patient or the provider to be physically onsite at the clinic?
Technically yes. The first “Four Walls Rule” reference was CMS’ FAQ issued as a result of the 2/26/16 CMS State Health Official letter SHO #16-002 that announced changes to Medicaid payment policy for tribal entities. Pre-PHE, this was never really thought of problematic. Post PHE:
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- For IHS and Tribal Facilities, the grace period for the “Four Walls” requirement has been extended to February 11, 2025. https://www.nihb.org/tribalhealthreform/cmcs-informational-bulletin-on-four-walls-grace-period-extended-through-february-2025/
- For hospital-based outpatient services, there is no longer a “Four Walls” requirement for mental health services – Hospital Without Walls for Mental/Behavioral Health Services has been made permanent.
- For FQHCs, the patient can be located anywhere in the US and in the protectorate states for mental/behavioral health services. Providers may continue to provide services from their homes. So the Four Walls requirement is not an issues here. https://www.cms.gov/files/document/se22001-mental-health-visits-telecommunications-rural-health-clinics-federally-qualified-health.pdf
- For all other outpatient mental health clinics, either the patient or provider must be physically onsite at the clinic but not both to comply with the Four Walls Rule. https://www.medicaid.gov/state-resource-center/downloads/spa-and-1915-waiver-processing/clinic-payment-methodology.pdf. The only exception is for services furnished to people who are homeless.
On November 1, 2025, CMS amended the Medicaid clinic services’ regulation to authorize Medicaid coverage for clinic services furnished by IHS/Tribal clinics outside the “four walls” of their facility. In addition, states implementing the Medicaid clinic services’ benefit can opt to cover clinic services furnished outside the “four walls” of behavioral health clinics or clinics located in rural areas. For clinics located in rural areas, based on comments received, CMS is finalizing an approach to defining “rural area” where states will select either a definition used by a federal agency for programmatic purposes, or a definition adopted by a state agency with a role in setting state rural health policy. The final rule takes effect on January 1, 2025.
- Can a Provider be located out of the country (either temporarily or permanently living abroad) and bill Medicaid for telehealth visits?
The short answer is No. Based on this CMS Guidance Letter to State Medicaid Directors, Section 6505 of the Affordable Care Act amends section 1902(a) of the Social Security Act (the Act), and requires that a State shall not provide any payments for items or services provided under the State plan or under a waiver to any financial institution or entity located outside of the United States (U.S.).
