State Policies Impacting TMAB Access for Medicaid Enrollees

GLOSSARY

• Telehealth: Telehealth enables health care clinicians to treat patients virtually without an in-person appointment. Patients can connect directly with a healthcare clinician from any location and this can be done in a variety of modalities ways, including via live synchronous video, synchronous audio-only, and asynchronous store-and-forward modalities, such as video (“synchronous”), the phone, secured chat (“asynchronous”), and other telecommunications. This can be delivered direct-to-patient, site-to-site, or via hybrid in-person/virtual care.

• Telehealth for Medication Abortion (“TMAB”): Generally refers to a patient’s use of a phone and/or video with a provider for some or all of the interactions to prescribe and receive medication abortion. TMAB can be direct-to-patient, site-to-site, or through a hybrid in-person/virtual care experience using different modalities.

• Hybrid Telehealth Care: The provision of telehealth for medication abortion care can be provided by telehealth in part, but not in entirety, because of state-mandated policies requiring a patient to have an in-person interaction.

• Medicaid: Medicaid, a joint federal and state program, is the largest source of federally supported health care coverage.  In exchange for federal funding, states must meet several requirements governing eligibility, what services must be provided, and protections for enrollees. While federal requirements establish a floor, states have flexibility in designing and administering their programs, including wide latitude over determining telehealth coverage.

• Abortion Coverage for Medicaid Enrollees: While federal funding for Medicaid abortion coverage is limited to cases of life endangerment, rape, or incest, states can use their funding to provide coverage for all abortions for Medicaid enrollees. Comprehensive insurance coverage is crucial to facilitating equitable abortion access.

• Hyde Amendment: The Hyde Amendment is an annual federal budget rider that restricts federal funding for abortion services to the narrow circumstances of rape, incest, or life endangerment.

• Telehealth Modalities: Telehealth care can occur in various forms known as “modalities.” While each state’s definition varies, the three primary forms of care are listed below:

  • Asynchronous Store-and-Forward: This modality allows patients and providers to exchange information, such as pictures, dynamic intake forms, lab results, and direct messages, to receive care in non-real-time interactions. Generally, the patient sends information and care requests to a provider that are then “stored” until the provider reviews it and responds. 

  • Synchronous Audio-Only: This modality uses real-time audio-only interactions between a patient and provider (such as telephone calls using a secure audio conferencing platform).

  • Synchronous Audio-Video Interactions: This modality uses a secure live video platform for interactions between a patient and a provider. It represents the most commonly covered modality and is often what people think of when considering telehealth service delivery.

  • Brick & Mortar Facility Requirement: A state-mandated requirement that a provider or clinic must have a brick-and-mortar facility or physical presence in the state to be eligible to enroll as a Medicaid provider and/or receive coverage for services. These requirements vary widely from state to state.