{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:55:15Z","timestamp":1791262515825,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["1RF1MH133436\u201001"],"award-info":[{"award-number":["1RF1MH133436\u201001"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000102","name":"Health Resources and Services Administration","doi-asserted-by":"publisher","award":["U66RH31459"],"award-info":[{"award-number":["U66RH31459"]}],"id":[{"id":"10.13039\/100000102","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>Telehealth increases access to health care services for patients, including rural and underserved communities, and a 50\u2010state survey of telehealth policies can further the study of the impact of telehealth on patient outcomes.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>This legal mapping study tracked telehealth policies by state Medicaid programs and found widespread adoption, especially in reimbursement for audio\u2010only telehealth (adopted by 0 to 43 states from 2018 to 2023).<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>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, unemployment, COVID\u201019 cases).<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Telehealth can improve access to medical and mental health care for rural and under\u2010resourced communities. US states rapidly expanded policies enabling telehealth care delivery during the COVID\u201019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Legal mapping (50\u2010state 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>A mean of 2.7 telehealth policies (standard deviation, 1.4; range, 0\u20106) were in effect across state Medicaid programs during the study period. Most adoption occurred during 2020 and 2021, with an audio\u2010only reimbursement policy being the most rapidly adopted, increasing from 0 to 43 states over the course of 5\u00a0years. 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\u201019 cases and deaths).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2010based health care tools, such as telehealth. This 50\u2010state survey can be used to understand policy effects on patient care access and quality for rural and underserved populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70117","type":"journal-article","created":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T13:09:57Z","timestamp":1786885797000},"page":"754-770","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expansion of State Medicaid Policies Related to Telehealth, 2018\u20102023: A National Legal Mapping Study"],"prefix":"10.1111","volume":"104","author":[{"given":"LUCINDA B.","family":"LEUNG","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine"},{"name":"Center for the Study of Healthcare Innovation, Implementation &amp; Policy, Veterans Affairs Greater Los Angeles Healthcare System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"VALERIE P.","family":"NGUYEN","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHRISTINE M.","family":"THOMPSON","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JASMEEN J.","family":"SANTOS","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CATHERINE E.","family":"BRAYTON","sequence":"additional","affiliation":[{"name":"Center for the Study of Healthcare Innovation, Implementation &amp; Policy, Veterans Affairs Greater Los Angeles Healthcare System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SUSAN L.","family":"ETTNER","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine"},{"name":"Fielding School of Public Health University of California  Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JOS\u00c9 J.","family":"ESCARCE","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine"},{"name":"Fielding School of Public Health University of California  Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3524-3454","authenticated-orcid":false,"given":"ALEXANDER D.","family":"MCCOURT","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10488\u2010019\u201000947\u2010w"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.focus.20190028"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19031749"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.15"},{"key":"e_1_2_6_6_1","unstructured":"BatemanN RossM.The pandemic hurt low\u2010wage workers the most\u2014and so far the recovery has helped them the least. 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