Assessing the Impact of Medicaid Telehealth Policy Change on Equitable Access to Telehealth Services in North Carolina

Shannon Dowler
Sam Thompson
Michelle Savuto
Jacqueline Marks-Smith
Jared Augenstein
September 2023


Evaluation of North Carolina’s updated Medicaid telehealth policies demonstrate that strategies are needed to address racial disparities in telehealth use and promote more equitable access.


In response to the COVID-19 pandemic, North Carolina's Department of Health and Human Services (NC DHHS) introduced several measures to promote broader telehealth adoption, including eliminating provider-distance requirements, enabling coverage of virtual patient communication services, expanding the range of eligible services and providers, and allowing services to be delivered through various secure technologies. The state also invested in telehealth infrastructure, broadband access, and enhanced financial support for primary care practices, and actively monitored telehealth utilization and access gaps to address disparities in member experience, particularly among underserved populations. In this brief, the authors evaluate the impact of these policy changes on equitable access to care within North Carolina Medicaid and the Children’s Health Insurance Program (CHIP).


The authors report that during the initial two years of the COVID-19 pandemic, adoption and use of telehealth services in North Carolina Medicaid varied significantly based on race and ethnicity, with Black members having the lowest telehealth use rates over time, despite state efforts to implement more flexible policies and invest in digital infrastructure. The authors report that differences in rates related to where telehealth is offered could have contributed to disparities in utilization among Black and Hispanic members.


North Carolina's experience underscores the need for more comprehensive strategies to ensure equitable access to telehealth services, especially among underserved communities. The authors highlight that to increase equitable access to telehealth and mitigate racial and ethnic disparities, requires different strategies than, for example, strategies used to improve access to telehealth services for rural communities. Strategies may include maintaining broad telehealth access post-pandemic, establishing remote technology hubs, and addressing implicit bias among health care providers.

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