At a time of social distancing and self-quarantines, many doctors say there is a better way for them to interact with patients but that Minnesota’s Medicaid program is standing in the way.
Telemedicine, which includes video chats, phone calls and online applications, is technically covered by Medicaid, but under the state’s laws and regulations, the Minnesota Department of Human Services often does not reimburse providers for these virtual office visits.
“Telemedicine is looking like a key way to care for patients in a safe way. However, the Minnesota DHS does not allow clinics to bill telemedicine visits for Medicaid patients, which is deeply frustrating and a source of care inequity,” said Dr. Mike Aylward of Minnesota Doctors for Health Equity.
A bill that would have loosened Medicaid rules on telemedicine did not pass the Legislature late Monday night. That bill would have also given DHS emergency authority to relax regulations in many programs that it runs that are limited by the COVID-19 pandemic.
A coalition of more than 200 organizations that serve clients in DHS programs is urging the state to take action.
“While our policymakers ensured we had critical resources for our Minnesota hospitals and health care institutions, close to a million Minnesotans still are at risk of losing essential supports and services that allow them to stay healthy and safe throughout this crisis,” said Laura Mortenson of the This Is Medicaid coalition.
Behind the scenes, some legislators were working on taking up the bill again, but no agreement has been announced.
“This has now become a must-pass bill in order to protect people’s ability to get treatment they need in their homes and at a distance as we encourage people to be apart,” said Sen. Jim Abeler, R-Anoka.
At the federal level, the Medicare insurance program for the elderly took steps this week to broaden telemedicine access because of the pandemic, including visits that take place on FaceTime or Skype.
The use of common smartphone apps eliminates a major barrier. Until now, Medicare telemedicine had to be done on equipment that meets federal online privacy and security standards.
In Minnesota, that requirement is still in place for Medicaid, which covers 1.1 million residents. As a result, sometimes people have to go to a clinic to have a telemedicine visit that qualifies. That often happens in rural areas where patients are connecting with specialists hundreds of miles away.
“If they need to see a nephrologist virtually they would have to come to our site,” said Dr. Deborah Dittberner, a family practitioner and chief medical officer of Alomere Health in Alexandria. Some of her patients drive 30 to 50 miles to access their health care.
Because psychiatrists are in such short supply, the same thing happens for people who want mental health treatment.
“Typically for psychiatry, people would go to a community mental health center and then be on a [qualified] system so they can access psychiatry,” said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness. “You can’t get reimbursed for phone [visits] and that is what we really need right now.”
Additionally, Minnesota law caps telemedicine visits at three per week. That can be problematic for someone who is in a crisis and might need to check in with a provider more frequently, Abderholden said.
Some patients don’t have internet access, which limits their access to telemedicine.
“I live in an area of the state with poor broadband, so telephone would be ideal,” said Dittberner.
While frustration with Medicaid’s telemedicine policies have been brewing for a while, the COVID-19 pandemic is adding new urgency to the issue.
The DHS was asking the Legislature for a package of emergency measures it could use if the pandemic forced closures of facilities, reduced the availability of qualified staff or resulted in the loss of services or health care.
“Right now we are exploring whatever flexibility we have, what authorities the governor might have and what the possibilities are for the Legislature coming back together to pass that bill or something like it,” DHS Commissioner Jodi Harpstead said.
“Our top priorities are providing a variety of mental health services by phone instead of in person,” Harpstead said. “Another one that has come up a lot is conducting required assessments of older adults and people with disabilities by phone instead of in person.”
Already, many disability service providers have shut down day activity centers.
Harpstead said that the department is looking at telemedicine and might make changes to its policies that would last beyond the pandemic.