The news: Therapists who are treating families, Medicaid beneficiaries, or patients from lower socioeconomic backgrounds are less likely to continue offering teletherapy post-pandemic, according to a new study published in JMIR.

• Conversely, therapists treating a higher percentage of older clients, Medicare patients, or patients from rural areas were more likely to continue using teletherapy post-pandemic.
• Researchers surveyed 114 US therapists from 27 states between January and April 2021.

Key drivers: Medicare is a more lucrative business model for clinicians than Medicaid.

• Medicaid reimburses providers at much lower rates than commercial insurers or Medicare Advantage. This makes it difficult for care providers that accept Medicaid to generate high revenues.
• It’s also more difficult to maintain a long-standing primary or mental health care engagement with Medicaid alone. Many patients are always coming on and off Medicaid, since eligibility is determined by income rather than age (like Medicare).

The problem: Medicaid patients could get left behind in the post-pandemic era.

The government mandated flexible telehealth policies (like payment parity) during the course of the pandemic, making it easier for Medicaid patients to access telehealth.

• From March 2020 through February 2021, physicians conducted 32.5 million telehealth services for nearly 5 million Medicaid beneficiaries in five states alone, according to the US Gov’t Accountability Office (GAO).
• That’s up from the 2.1 million telehealth services delivered to 455,000 beneficiaries a year prior to the pandemic.

But with fewer therapists planning to continue virtual care for Medicaid patients post-pandemic, it could leave many patients unable to afford out-of-pocket costs of virtual care.

• That’s bad news for US health outcomes. Telehealth makes it easier for patients to get access to regular care than an in-person visit alone.
• About 24% of adults said they’ve skipped or delayed a visit to a doctor’s office due to cost, per an October 2021 KFF poll. And 17% of adults said the same about mental health care.