Can Telehealth Bridge the Gap in Opioid Use Disorder Treatment? For Medicaid Patients, the Answer is Complicated

by Jon Scaccia January 8, 2025

Imagine this: A single mother in Illinois struggles to balance work, childcare, and her battle with opioid use disorder (OUD). The COVID-19 pandemic, which upended daily life for millions, seems like it could provide a silver lining: telehealth services, offering remote access to essential treatment. But for her and many others on Medicaid, the promise of telehealth is proving to be a broken one.

As this mother picks up her phone for what should be a lifeline, she faces hurdles: no internet, limited data, or a lack of familiarity with the technology. This isn’t just her story—it’s the reality for thousands of Medicaid patients across the U.S. This blog dives into recent research uncovering how telehealth, while a boon for some, has unintentionally widened treatment gaps for others.

The Rise of Telehealth: A Pandemic-Era Innovation

When COVID-19 forced people indoors, healthcare adapted. Telehealth, a relatively niche service pre-pandemic, became a mainstream solution almost overnight. For those with OUD, telehealth seemed especially promising—it could eliminate common barriers like transportation, stigma, and scheduling conflicts.

However, a study conducted at Northwestern Medicine revealed stark disparities in who benefitted. The researchers examined the impact of telehealth expansion on Medicaid enrollees compared to privately insured individuals. Their findings are troubling: while telehealth helped privately insured patients maintain access to care, Medicaid enrollees were 43.7% less likely to receive any treatment during the pandemic.

Understanding the Gap: Why Medicaid Patients Fell Behind

So, why the disparity? The study highlights several factors:

1. Access to Technology: Medicaid enrollees are less likely to have high-speed internet, smartphones, or computers—essential tools for telehealth.
2. Digital Literacy: Navigating telehealth platforms can be daunting for patients unfamiliar with technology.
3. System Strain: Federally Qualified Health Centers (FQHCs) often stepped in to provide care for Medicaid patients during the pandemic, but these centers may not have robust telehealth systems.

The numbers paint a clear picture. Before the pandemic, Medicaid patients were slightly more likely to receive OUD care than their privately insured counterparts. But as telehealth became the dominant mode of treatment, Medicaid enrollees experienced a 64.2% drop in telehealth usage compared to privately insured individuals.

The Human Cost of Disparities in Telehealth

Behind these statistics are real people. Consider James, a 42-year-old Medicaid enrollee from Chicago. Pre-pandemic, he visited a local clinic for regular OUD counseling. When the clinic pivoted to telehealth, James found himself unable to participate—his phone was outdated, and he lacked reliable internet.

Meanwhile, Sarah, who has private insurance, seamlessly transitioned to telehealth appointments. Her employer provided her with a work laptop, and her broadband connection at home ensured uninterrupted care.

The result? While Sarah maintained her progress in treatment, James fell through the cracks, putting him at greater risk of relapse and overdose.

The Policy Problem: Why Equitable Access Matters

The disparities uncovered by this study have far-reaching implications. Medicaid patients make up nearly half of adults diagnosed with OUD in the U.S. If telehealth policies fail to address their needs, the already dire opioid epidemic could worsen.

Moreover, the research underscores the importance of tailoring telehealth policies to vulnerable populations. For instance, Illinois Medicaid reimbursed telehealth visits at the same rate as in-person visits, theoretically removing cost as a barrier. Yet, systemic challenges—like lack of trust or implicit bias—may still have deterred providers from engaging with Medicaid patients via telehealth.

A Roadmap for Closing the Gap

The study offers valuable lessons for the future of telehealth. Policymakers, healthcare systems, and community organizations can take several steps to address disparities:

• Digital Access Programs: Provide Medicaid patients with devices or internet access, modeled after school laptop loan programs.
• Telehealth Training: Develop user-friendly platforms and offer digital literacy workshops for patients.
• Community-Based Solutions: Partner with organizations like FQHCs to integrate telehealth into existing care models.
• Policy Reforms: Align federal and state regulations to ensure consistent access and reimbursement across all populations.

What’s Next? Challenges and Opportunities

The rise of telehealth is far from over. As the pandemic recedes, many states are reevaluating telehealth policies, creating a critical window to address gaps. Future research must explore whether innovations like digital navigators or telehealth-specific care teams can help Medicaid patients overcome barriers.

Policymakers should also examine how expanded confidentiality protections, such as those under the 2024 final rule aligning 42 CFR Part 2 with HIPAA, can reduce stigma and improve engagement for OUD patients.

Finally, addressing disparities in telehealth isn’t just about improving access—it’s about saving lives. In 2021 alone, opioid-related overdose deaths reached a staggering 80,000. Ensuring equitable access to OUD treatment could prevent many of these tragedies.

Join the Conversation

What do you think about the findings from this study?

• Have you or someone you know faced barriers to telehealth services?
• What policy changes or innovations do you believe could make telehealth more equitable for Medicaid patients?
• How can public health practitioners and community organizations work together to bridge these gaps?

Share your thoughts in the comments or join the discussion on social media. Together, we can ensure that telehealth reaches its full potential—for everyone.

Join the Community – Get Your Weekly Public Health Update!

Be a health leader! Subscribe for free and share this blog to shape the future of public health together. If you liked this blog, please share it! Your referrals help This Week in Public Health reach new readers.