Impact of Telehealth Reimbursement Policies on Federally Qualified Health Centers

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Many would agree that over the past five years or so, telehealth has skyrocketed in popularity, as another way to provide clinical healthcare, increasing access to mental health and managed care.^1-4 Nevertheless, this is a double-edged sword—for all its benefits, the argument could also be made that telehealth could worsen existing health disparities due to the fact that utilizing its services involves internet access and digital literacy, which are tied to age, race, English proficiency, socioeconomic levels, and other factors tied to structural determinants of health.⁵

This also opens up the door to potential disparities in quality care as the technology continues to develop between individuals who are able to access care via video-based platforms versus audio only, and even between insurance types.⁵ In fact, various reports indicate that some insurance plans do not reimburse the same amount for services that are provided via telehealth versus in-person (although some may do so).⁵

Keeping all of this in mind, federally qualified health centers (FQHCs) primarily count on Medicaid to pay practitioners for providing low-cost primary care services to approximately 1 in 12 people needing mental and physical healthcare but are currently experiencing a workforce crisis for reasons that are yet to be determined.

In order to dig into this issue further, a qualitative study published in JAMA Network Open⁵ sought to determine how in fact Medicaid telehealth reimbursement policies are perceived by various members of FQHC leadership and staff.

The study consisted of virtual and in-person interviews that were conducted from April 2022 to January 2024—investigators gathered a sample of six community health center (CHC) sites across New York City’s five boroughs by reaching out via email. They recruited participants by utilizing a snowball sampling approach, a technique in which participants identify other individuals who might be interested in participating.

In total, the team conducted 56 semi-structured interviews, with 26 of those participants being part of the leadership team (46.4%), 18 (32.1%) being clinical staff, eight (14.3%) being program support staff, seven (12.5%) being enabling services staff, three (5.4%) being site directors, and three (5.4%) falling under another staff category.

The study’s findings showed that despite telehealth bringing new opportunities to advance patient-centered care, obstacles in terms of equitable care remain, due to telehealth not full being incorporated into payment in a way that’s viable. There are three main themes that influenced the impact of Medicaid telehealth reimbursement policies on FQHCs, including that the design of Medicaid telehealth policies was seen as contributing to a shortage of healthcare workers, especially among mental health professionals; patients had varied preferences and levels of access to telehealth, while FQHCs faced challenges in securing the necessary resources for telehealth services; and FQHC leadership envisioned a successful hybrid model where telehealth would enhance, rather than replace, in-person care.

Overall, investigators concluded that, “ ... FQHC leadership and staff perceived telehealth Medicaid reimbursement policies in New York State as a factor that exacerbates inequities to access care, particularly for mental health needs. FQHCs staff and leadership reported opportunities to improve compliance, no-shows, and workflows through telehealth, but improvements in funding policy such as payment parity and more grants that can be used to address telehealth infrastructure (eg, Internet access, equipment, and literacy) are urgently needed.”

References

1. Lynch DA, Stefancic A, Cabassa LJ, Medalia A. Client, clinician, and administrator factors associated with the successful acceptance of a telehealth comprehensive recovery service: a mixed methods study. Psychiatry Res. 2021;300:113871. doi:10.1016/j.psychres.2021.113871

2. Tse J, LaStella D, Chow E, et al. Telehealth acceptability and feasibility among people served in a community behavioral health system during the COVID-19 pandemic. Psychiatr Serv. 2021;72(6):654-660. doi:10.1176/appi.ps.202000623

3. Abuyadek RM, Hammouda EA, Elrewany E, et al. Acceptability of tele-mental health services among users: a systematic review and meta-analysis. BMC Public Health. 2024;24(1):1143. doi:10.1186/s12889-024-18436-7

4. Zhang Y, Leuk JSP, Teo WP. Domains, feasibility, effectiveness, cost, and acceptability of telehealth in aging care: scoping review of systematic reviews. JMIR Aging. 2023;6(1):e40460. doi:10.2196/40460

5. Porteny T, Brophy SA, Burroughs E. Experiences of Telehealth Reimbursement Policies in Federally Qualified Health Centers. JAMA Netw Open. 2025;8(2):e2459554. doi:10.1001/jamanetworkopen.2024.59554