A groundbreaking study from the University of Michigan reveals the transformative impact telehealth services have had on improving healthcare access for Medicaid expansion enrollees in Michigan, particularly those with low incomes and significant barriers to traditional care. By leveraging video visits and telephone consultations, millions of vulnerable individuals are now receiving medical attention they would have otherwise foregone, an advancement poised to reshape how public health institutions conceive accessibility in the digital age.
Analyzing data collected from over 4,000 Healthy Michigan Plan beneficiaries during 2021 and 2022, the research uncovers that nearly one-third of enrollees utilized telehealth services at least once in the previous year. This uptake is especially notable in urban areas, where infrastructural advantages facilitate video-based encounters, underscoring telehealth’s potential to bridge geographical divides. Approximately two-thirds of these virtual visits occurred over video platforms, signaling a preference for interactive technologies despite known disparities in internet connectivity.
One of the most striking findings was that a remarkable 63% of telehealth users credited these encounters with providing care they could not have otherwise accessed, emphasizing telehealth’s role as a critical lifeline. This statistic is exceptional because it quantifies patient-perceived gaps in healthcare access prior to the expansion of virtual services and contextualizes telehealth as a pragmatic solution to longstanding systemic challenges. These results highlight telehealth’s capacity to alleviate difficulties such as transportation issues, inflexible work schedules, and caregiving obligations, which disproportionately affect low-income populations.
Importantly, the study delineates the characteristics of individuals who are most likely to rely on telehealth. Medicaid enrollees who have an established primary care provider yet report barriers to in-person care demonstrated a higher propensity for virtual visits compared to those without such barriers, suggesting telehealth fills critical gaps in continuity of care. Moreover, even among participants expressing discomfort with the internet or lacking online patient portal accounts, telehealth usage was non-negligible, dispelling assumptions that digital literacy fully dictates telehealth adoption.
Despite some users lacking what is conventionally deemed adequate internet access—12% of telehealth users reported unreliable connectivity—the reliance on televisits underscores the adaptability and resilience of Medicaid enrollees in leveraging available technology. This phenomenon points to an urgent need for health policy frameworks to address the digital divide, as telehealth’s effectiveness partly hinges on robust broadband infrastructure and user-friendly platforms to maximize engagement and care quality.
Demographic disparities emerged as a critical dimension within the usage patterns identified. White, non-Hispanic enrollees were significantly more likely to engage in telehealth services than Black, Hispanic, or Arab, Chaldean, and Middle Eastern participants. This racial and ethnic gulf is troubling, intimating deep-rooted inequities in access or comfort with telehealth modalities. The finding signals an imperative for future interventions to be tailored towards reducing racial disparities and ensuring equitable access to emergent healthcare technologies.
Geographical factors further nuanced the telehealth landscape. Paradoxically, those residing in rural areas, who often face pronounced physical barriers to healthcare, exhibited a higher percentage of video visit usage compared to urban and suburban counterparts. This suggests that telehealth, particularly through video-enabled platforms, could play a vital role in mitigating rural healthcare access challenges, yet also underlines the complexity of infrastructure variability, broadband penetration, and technological proficiency across different regions.
Survey participants consistently reported high satisfaction with telehealth experiences, with 92% affirming that their health concerns were adequately addressed during virtual consultations. This level of patient endorsement affirms telehealth’s viability as an effective episode of care and bolsters arguments for its continued inclusion in Medicaid and Medicare reimbursement policies. The findings come at a critical juncture as legislative decisions loom over whether expanded telehealth coverage will be extended beyond emergency waivers.
The study, led by Dr. Terrence Liu of the U-M Medical School’s Division of General Internal Medicine, is part of a broader evaluation conducted by the Institute for Healthcare Policy and Innovation in partnership with the Michigan Department of Health and Human Services. This comprehensive analysis satisfies federal conditions tied to the Healthy Michigan Plan’s Medicaid expansion waiver, spanning the period of 2019 through 2023, and provides rich, policy-relevant insights into Medicaid enrollee behaviors and preferences amid the digital healthcare revolution.
In the context of health economics and policy, telehealth’s ascendancy also alleviates systemic cost pressures by reducing no-show rates, minimizing unnecessary emergency room visits, and optimizing physician time allocation. For Medicaid expansion enrollees, who are often juggling complex socio-economic constraints, virtual health platforms offer a flexible solution that aligns care delivery with the realities of their daily lives, fostering more sustainable engagement with the healthcare system.
Nonetheless, the study’s revelations prompt critical reflections on the infrastructure, technological literacy, and socio-cultural factors that continue to shape telehealth adoption. Addressing internet access disparities and ensuring culturally competent digital outreach will be vital to democratize telehealth’s benefits. The differential usage rates across racial groups and geographical locales illuminate enduring structural inequities that require deliberate policy action to guarantee telehealth’s promise reaches all segments of the Medicaid population equitably.
As policymakers deliberate the future of telehealth within federal Medicare and Medicaid programs, these findings serve as an evidentiary foundation emphasizing telehealth’s potential not just as a pandemic contingency but as a durable, inclusive modality to surmount enduring healthcare access barriers. The compelling patient satisfaction and demonstrable reach among vulnerable populations argue persuasively for integrating telehealth as a standard component of Medicaid-covered benefits.
The Healthy Michigan Plan’s experience crystallizes the paradigm shift in healthcare delivery ushered in by telehealth. By facilitating connections where physical or systemic barriers impede traditional care, telehealth embodies a digital frontier with the power to redefine equity in health access. Continued research and careful policy stewardship will determine how broadly and effectively these virtual lifelines can be woven into America’s healthcare fabric for the most underserved communities.
Subject of Research: People
Article Title: Utilization and Patient Experiences of Telehealth Among Medicaid Expansion Enrollees
News Publication Date: 21-Mar-2025
Web References: http://dx.doi.org/10.1093/haschl/qxaf060
References: University of Michigan Institute for Healthcare Policy and Innovation, Michigan Department of Health and Human Services
Keywords: Health care policy, Telephones, Public health, Internet, Poverty, Smartphones
