The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest posts from our staff and guest authors.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a foundation that works to improve population health and health equity.
August 19, 2026
Quarterly Article
Lucinda B. Leung
Valerie P. Nguyen
Christine M. Thompson
Jasmeen J. Santos
Catherine E. Brayton
Susan L. Ettner
José J. Escarce
Alexander D. McCourt
Aug 19, 2026
Jun 1, 2026
June 2026
Back to The Milbank Quarterly
Policy Points:
Context: Telehealth can improve access to medical and mental health care for rural and under-resourced communities. US states rapidly expanded policies enabling telehealth care delivery during the COVID-19 pandemic, possibly driven by certain state factors, such as rurality. Variation in state policies regarding Medicaid, the largest US health insurance program by enrollment, enables the naturalistic study of telehealth care expansion and health outcomes for underserved individuals. This study aimed to identify state policies addressing Medicaid telehealth care delivery and to examine explanatory state factors associated with telehealth adoption.
Methods: Legal mapping (50-state survey) methods were used to identify US state laws and policies addressing telehealth for Medicaid populations in effect up to December 31, 2023. Two researchers independently abstracted relevant information and analyzed data, guided by a supervising public health attorney and physician. The main outcome was the count of (equally weighted) policies in effect during each month by state. Multivariable regressions were used to examine the data for associations between policy counts and several potential explanatory state factors from 2018 to 2023.
Findings: A mean of 2.7 telehealth policies (standard deviation, 1.4; range, 0-6) were in effect across state Medicaid programs during the study period. Most adoption occurred during 2020 and 2021, with an audio-only reimbursement policy being the most rapidly adopted, increasing from 0 to 43 states over the course of 5 years. State adoption of telehealth policies appeared to be independent of rurality, health professional shortage, Medicaid expansion, broadband internet availability, and any tested state factor (e.g., demographics, income, unemployment, COVID-19 cases and deaths).
Conclusions: States rapidly enacted many Medicaid policies to facilitate telehealth care delivery, which was not driven by any singular state factor. Policy plays an important role in the implementation of evidence-based health care tools, such as telehealth. This 50-state survey can be used to understand policy effects on patient care access and quality for rural and underserved populations.
