Medicaid Telehealth Coverage: The Modalities States Pay For

Medicaid is where telehealth coverage varies most, because there are as many telehealth policies as there are programs. Federal Medicaid law leaves states wide latitude over whether and how to pay for services delivered by telehealth, so each state sets its own rules in statute, regulation, provider manuals, bulletins and fee schedules, and often separately for fee-for-service and managed care. The best single national source is the Center for Connected Health Policy (CCHP), whose Fall 2025 summary reflects its review of state policies conducted between late May and early September 2025. Its next annual report is expected around November 2026.

Which modalities do state Medicaid programs pay for?

CCHP's Fall 2025 counts, by modality:

• Live video: all 50 states, DC and Puerto Rico reimburse some form of live video in fee-for-service Medicaid. The Virgin Islands does not explicitly say it does in its permanent policies.
• Audio-only: 46 states and DC reimburse telephone-based services in some capacity, "often with limitations." New Jersey was the only state added since Fall 2024.
• Remote patient monitoring: 41 states.
• Store-and-forward: 40 states, a count that excludes programs limiting it to teleradiology. Connecticut and New Jersey were added, each in a limited way.

CCHP lists 32 state programs that reimburse all four modalities, with limitations: Alaska, Arkansas, Arizona, California, Colorado, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington and Wisconsin.

What limits come with live video?

CCHP groups Medicaid restrictions on live video into three areas: which providers may be paid (and where they may be located), which services are eligible, and where the patient must be (the originating site). The trend is toward fewer limits:

• Providers. Most programs now allow a wide range of providers, often without limiting where they practice from. Colorado expanded its "treating practitioner" definition to include specialists in its Accountable Care Collaborative.
• Home as originating site. 48 states and DC explicitly recognize the patient's home, often with added limitations, and providers generally cannot bill a facility fee for home visits.
• Originating site lists. 16 states and DC still list the facilities that qualify as originating sites, though many lists now include homes or schools.
• Geographic limits. Only Hawaii and Maryland still carry geographic restrictions in their policies, and CCHP suggests both may be outdated administrative language that conflicts with newer statutes.
• Facility fees. 35 programs pay a facility fee to qualifying originating sites, not when the patient is at home.

How do programs handle audio-only?

Most have moved from emergency allowances to permanent policy, but the mechanics differ. CCHP reports that Michigan, Alaska, Montana and Kansas have dropped the temporary audio-only E/M codes 99441 to 99443 in favor of standard E/M codes with modifiers, while North Carolina and Ohio adopted the newer AMA telehealth codes, including audio-only codes, for therapy and counseling. The District of Columbia declined to cover those new codes. Missouri revised its statutory definition of telehealth to include audio-only, and Nebraska amended its rules to allow audio-only for behavioral health.

The common limits are behavioral health only, established patients only, or audio-only only when video is not available. Medicare's own audio-only rules, which run through December 31, 2027, are separate; see audio-only telehealth rules.

What about store-and-forward and eConsults?

Some programs still limit telehealth to "real-time" or "interactive" services, which excludes store-and-forward. Others pay for it only through communication technology-based service (CTBS) codes; CCHP names Connecticut, Illinois, North Carolina, New Hampshire, New Jersey, Ohio, Pennsylvania and South Carolina. Maine clarified that text messaging is not telehealth. CCHP also notes that CMS guidance permits Medicaid to pay for interprofessional eConsults through CTBS codes, and New York and California have expanded that coverage. Asynchronous practice rules are a separate state law question; see asynchronous telehealth by state.

And remote patient monitoring?

Medicaid RPM coverage does not always mirror Medicare's codes. CCHP gives examples: Alabama's RPM manual sets one-year orders and initial and annual home assessments; New York added CPT 99457 and extended RPM to some FQHCs; Maryland expanded RPM to patients with any condition and dropped prior authorization; California removed its 21-and-over age requirement. Programs that pay for RPM often limit it by condition, prior authorization or provider type. For program design, see setting up a remote patient monitoring program.

Do FQHCs and RHCs get paid for telehealth under Medicaid?

Usually, with specific billing rules. CCHP counts 40 states and DC that explicitly authorize FQHCs, RHCs or both as distant site providers, and 35 states and DC that allow FQHCs as originating sites. Indiana, for example, pays the FQHC or RHC encounter at its prospective payment system rate when the service is both a valid encounter and a covered telehealth service. Billing mechanics belong with a billing team; our sister company White Glove Medical Billing handles claims.

Does Medicaid pay telehealth at the in-person rate?

Many programs do, by policy or statute, but it is not universal. CCHP notes that Kansas Medicaid reimburses all telemedicine encounters at the same rate as comparable in-person visits, and that Oregon's school-based health services rule requires the same rate as in-person care. New Jersey's payment parity law, extended through December 31, 2027 by P.L.2026, c.29 (signed June 30, 2026), applies to Medicaid and NJ FamilyCare as well as commercial plans, according to a Brach Eichler summary. Most commercial parity statutes do not reach Medicaid; see telehealth payment parity laws.

Are there Medicaid-specific consent or practice rules?

Often. In several states the only telehealth consent requirement we found was in Medicaid policy. Pennsylvania's Medical Assistance program, for example, requires providers to obtain consent before a telehealth service and to let beneficiaries return to in-person care at any time (Medical Assistance Bulletin 99-23-08). A Medicaid service line needs the program's own consent and documentation rules alongside the state's licensing rules. See telehealth consent requirements.

How do you check a state before launching a Medicaid service line?

1. Read the current provider manual and the latest bulletins, not just the statute. CCHP notes that some states, such as Connecticut, still publish telehealth rules mainly through bulletins.
2. Check fee-for-service and each managed care plan separately. Plans can add requirements, and California has issued separate guidance on telehealth in managed care for FQHCs, RHCs and Indian Health Services.
3. Confirm the modality and the service. A program that covers audio-only for therapy may not cover it for an E/M visit.
4. Confirm provider eligibility and enrollment, including whether out-of-state providers may enroll. Payer enrollment goes through White Glove Credentialing.
5. Record the place of service and modifiers the program requires for home and non-home visits.
6. Recheck after CCHP's Fall 2026 report and whenever the program issues a bulletin.

Our 50-State Telehealth Matrix ($2,950 for one service line, $1,250 each additional) can add a Medicaid coverage layer for the states you serve, and the Compliance Calendar & Rule Watch ($495 per month) tracks program bulletins. This is research for your counsel and billing team, not legal or billing advice.