Using administrative data to examine telemedicine usage among Medicaid beneficiaries during the Coronavirus Disease 2019 pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic necessitated the replacement of in-person physician consultations with telemedicine. During the pandemic, Medicaid covered the cost of telemedicine visits. Objectives: The aim was to measure the adoption of telemedicine during the pandemic. We focus on key patient subgroups including those with chronic conditions, those living in urban versus rural areas, and different age groups. Methods: This study examined the universe of claims made by Florida Medicaid beneficiaries (n=2.4 million) between January 2019 and July 2020. Outpatient visits were identified as in-person or telemedicine. Telemedicine visits were classified into audio-visual or audio-only visits. Results: We find that telemedicine offsets much of the decline in in-person outpatient visits among Florida’s Medicaid enrollees, however, uptake differs by enrollee type. High utilizers of care and beneficiaries with chronic conditions were significantly more likely to use telemedicine, while enrollees living in rural areas and health professional shortage areas were moderately less likely to use telemedicine. Elderly Medicaid recipients (dual-eligibles) used audio-only telemedicine visits at higher rates than other age groups, and the demand for these consultations is more persistent. Conclusions: Telemedicine offset the decline in health care utilization among Florida’s Medicaid-enrolled population during the novel coronavirus pandemic, with particularly high uptake among those with prior histories of high utilization. Audio-only visits are a potentially important method of delivery for the oldest Medicaid beneficiaries