Government Accountability Office Asks CMS to Assess Quality of Telehealth for Medicaid Beneficiaries


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The US Government Accountability Office is asking the Centers for Medicare and Medicaid Services to assess the effect of an increase in the use of telehealth on the quality of care received by Medicaid beneficiaries.

The GAO cited statistics showing that usage continues to increase.

The GAO collected data from five states – Arizona, California, Maine, Mississippi and Missouri – and found exponential increases in the number and percentage of services delivered via telehealth, as well as the number of Medicaid beneficiaries receiving care remotely. .

For example, from March 2020 to February 2021, 32.5 million services were provided via telehealth, compared to 2.1 million services the previous year.

The number of Medicaid beneficiaries using the technology is also on the rise, with 4.9 million beneficiaries in these five states receiving telehealth services during this period, compared to only 455,000 during the 12 months preceding the COVID-19 pandemic.

The percentage of Medicaid patients receiving at least one service via telehealth increased significantly in all five states, with the largest increase occurring in Maine: From March 2019 to February 2020, only 2.5% of Maine Medicaid enrollees used a telehealth service. From March 2020 to February 2021, that number jumped to 41.8%.

California posted a similar increase (2.5% vs. 41.4%), as did Arizona (11% vs. 43.8%). Mississippi saw the percentage jump from 1.2% to 25.4%, while Missouri saw a jump from 2.3% to 19.9%.


To respond to the COVID-19 pandemic, states have expanded their telehealth coverage in Medicaid.

The CARES Act includes a provision for the GAO to report on the federal response to the pandemic, and the agency has also been asked to review the use of Medicaid flexibilities in response to the pandemic.

The GAO analyzed state-reported data on telehealth use in five states, based in part on geographic variation, size of the Medicaid program, and percentage of the population living in rural areas. The GAO reviewed federal surveillance documents, interviewed state and federal Medicaid officials, and assessed CMS surveillance against its guidelines on using data to identify health care disparities and target improvements.

CMS does not collect, evaluate, or report information about the effects of service delivery via telehealth on the quality of care Medicaid recipients receive, and does not intend to do so, said the GAO. That’s what he hopes to change.

“It would also be consistent with how CMS has encouraged states to use quality of care data to identify health care disparities and target opportunities for improvement to advance health equity,” the GAO said.

These efforts could start with data for quality measures that CMS already collects or through other means.

CMS has not issued a response to the GAO recommendations.


To help beneficiaries maintain access to care under stay-at-home orders to reduce COVID-19-related exposure, CMS has used the emergency waiver authorities enacted by Congress, as well as the existing regulatory authorities, to implement policies expanding access to telehealth services during the pandemic.

These included the lifting of several legal limitations, such as geographic restrictions, and the ability for beneficiaries to benefit from telehealth in their homes.

The use of telehealth has increased 63 times during the pandemic, according to a December 2021 report from the US Department of Health and Human Services. Behavioral health providers saw the highest use of telehealth, with a 32-fold increase, HHS said.

In 2020, telehealth visits accounted for one-third of total visits to behavioral health specialists, compared to 8% of visits to primary care providers and 3% of visits to other specialists.

While the use of telehealth services has increased and improved access to services for many beneficiaries, further research is needed to understand the impact on quality of care and why some beneficiaries used telehealth less than others. others, HHS said.

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