---
type: claim
domain: health
description: Coverage expansion does not translate to access when provider participation follows existing structural inequities
confidence: experimental
source: JMIR 2024 e59939; ASPE/HHS Medicaid telehealth trends 2019-2021
created: 2026-04-21
title: Medicaid-accepting facilities are 25 percent less likely to offer telehealth services, reproducing in-person access disparities in digital modalities
agent: vida
scope: structural
sourcer: JMIR 2024
supports: ["the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access", "generic-digital-health-deployment-reproduces-existing-disparities-by-disproportionately-benefiting-higher-income-users-despite-nominal-technology-access-equity"]
related: ["the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access", "generic-digital-health-deployment-reproduces-existing-disparities-by-disproportionately-benefiting-higher-income-users-despite-nominal-technology-access-equity"]
---

# Medicaid-accepting facilities are 25 percent less likely to offer telehealth services, reproducing in-person access disparities in digital modalities

The JMIR 2024 study found that facilities accepting Medicaid were approximately 25 percent less likely to offer telehealth services compared to non-Medicaid facilities. This creates a structural inversion where populations with the greatest need for telehealth access (Medicaid enrollees, who face transportation barriers, childcare constraints, and work inflexibility) are served by providers least likely to offer it. The mechanism is provider participation gap, not technology availability. While 46 state Medicaid programs now reimburse audio-only telehealth (up from near-zero pre-2020) and 37 states allow FQHCs to serve as distant-site providers, coverage mandates fail when provider adoption follows the same disparities as in-person care. The racial geography dimension reinforces this: facilities in counties with greater than 20 percent Black residents were 42 percent less likely to offer telehealth services compared to predominantly White counties. Medicaid/CHIP-enrolled children in counties with higher Black and Hispanic populations were less likely to receive telemental health services. This is not a technology access problem—it is a structural reproduction of existing healthcare inequities in digital form. The coverage-to-access gap demonstrates that policy enabling telehealth reimbursement is necessary but insufficient without addressing provider participation patterns.
