The California Department of Health Care Services (DHCS) recently released a set of broad-based telehealth policy recommendations. While making certain COVID-19 flexibilities permanent following the end of the public health emergency, the recommendations fall short in supporting equitable access to telehealth services. 

Specifically, DHCS’ proposal, which is focused on the Medi-Cal population, would modify, or expand the use of telehealth in various formats, including video, phone, and remote patient monitoring, but does not extend them equally beyond the pandemic. The proposal suggests creating a separate, lower fee schedule for telephone visits, which would create access barriers for many elderly, underserved and rural patients. In addition, although the proposed policy includes the expansion of video visits for federally qualified health centers (FQHCs) and the removal of barriers limiting the use of video, FQHC audio visits would not be eligible for reimbursement. Other non-FQHC providers in hospitals and clinics could be reimbursed for audio visits, but only at a lower rate than in-person visits.  

Audio visits are critical for vulnerable patients. Homeless populations, essential workers, those who need privacy, and others may lack access to the internet, home computers, or may have limited data plans. Varying levels of digital literacy and comfort with technology may also play a role in patients’ ability to use video.

Health care advocates and providers call on the Legislature and Governor to support a comprehensive telehealth policy that builds off lessons learned during the pandemic, meets the demand for virtual remote care, and ensures access for all populations.

“As we continue to wrestle with the pandemic and to work towards a more equitable health care landscape, providing and sustaining access to care through telehealth must remain a priority,” said California Medical Association (CMA) President Peter N. Bretan, Jr., M.D. “Telehealth has become an essential tool for physicians’ practices during this time because it allows them to provide safe and effective care to their patients. Additionally, telehealth bridges access barriers by utilizing technology to better harness physician time and expertise, and connecting patients to their care providers more quickly, efficiently and conveniently. Protecting the telehealth expansions, especially those that relate to telephonic visits which play a crucial role in bridging access barriers, is essential to both meeting our health care demands in this moment, and to ensuring that all Californians – regardless of their geography, income, or background - can receive access to quality care in the future.”

CMA and a broad coalition of health care providers and advocacy groups are urging the legislature to pass AB 32 (Aguiar-Curry), which offers California a telehealth solution that is inclusive, fair and ensures equal access to care for all Californians. Policy changes outlined in AB 32 include: creating payment parity between Medi-Cal managed care plans and commercial plans and allowing virtual enrollment for limited scope Medi-Cal programs. Additionally, the intent of the bill is to continue the provision of telehealth in Medi-Cal programs, including video and audio-only technology, by making the telehealth flexibilities instituted during the public health emergency permanent.

If passed, AB 32 will be a critical component of California’s telehealth policy infrastructure and would help pave the way for future health care innovation and advancement.