MO is one of 27 states that do not require private insurance to cover audio-only telehealth.
People of color and individuals with low incomes are the most reliant on audio-only telehealth.
There is little research on the clinical and monetary effects of audio-only telehealth.
Twenty-three states and D.C. require private insurance to cover audio-only telehealth (Figure 1; Center for Connected Health Policy 2024).
In response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) allowed the use of audio-only services under a federal waiver (CMS 2023).
Audio-only telehealth is more likely to be used by (U.S. Department of Health and Human Services (DHHS) 2022):
Video telehealth is more likely to be used by (U.S. DHHS 2022):
Twenty percent of Missourians and 61% of rural Missourians do not have high speed internet (Missouri Foundation for Health 2020).
One national study shows that removing access to audio-only telehealth would lead to the largest reduction of access to healthcare for Hispanic individuals, followed by non-Hispanic Black individuals (Kleinman & Sanches 2022). Removing access to audio-only telehealth would disproportionally affect individuals age 80+, people with incomes less than $25,000, the uninsured, and people with health care through the Veterans Affair, Indian Health Service, Medicare, and Medicaid.
A review of the United Kingdom, Australia, Canada, and the U.S. found that for the management of an established diagnosis, there is no difference in clinical effectiveness, patient satisfaction, and cost-effectiveness between audio-only and video telehealth (Byambasuren et al. 2023). For the care of chronic conditions such as renal disease or diabetes, there was no difference between audio-only, in-person, and hybrid care (Moran et al. 2022)
When adding audio-only telehealth to the usual care for depression, patients reported improved anxiety, access to support and advice, satisfaction, and self-management (Salisbury et al. 2016).
When using audio-only telehealth for prenatal visits, patients had positive opinions about using audio-only telehealth and reported less time away from work, resulting in less lost wages (Holcomb et al. 2020). Audio-only visits were more likely than in-person visits to be completed as scheduled. However, wait times were longer for audio-only visits compared to in-person visits.
Figure 1. States with Medicaid coverage of audio-only telehealth. The map shows states that cover audio-only telehelath under Medicaid through statute or the Public Health Emergency. For a full list of references on state coverage please see below.
7 Alaska Admin. Code § 110.625 (2023). https://www.akleg.gov/basis/aac.asp#7.110.625.
18 Vt. Stat. Ann. § 9362 (2021). https://legislature.vermont.gov/statutes/section/18/219/09362.
24 Me. Rev. Stat. 56 § 4316 (2021). https://legislature.maine.gov/statutes/24-a/title24-Asec4316.html.
062-7 Wyo. Rev. Code § 7-9 (2022). https://www.law.cornell.edu/regulations/wyoming/062-7-Wyo-Code-R-SS-7-9.
225 Ill. Compiled Stat. (2022). https://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=3807.
907 Ky. Rev. Stat. 3 § 170 (2022). https://apps.legislature.ky.gov/law/kar/titles/907/003/170/.
AB 133, 2021-2022 Regular Session (Cal. 2021) https://legiscan.com/CA/text/AB133/id/2426274.
Ariz. Rev. Stat. § 20-841.09 (2021). Link.
Ark. State Code § 23-79-1601 (2021). Link.
Byambasuren O, Greenwood H, Bakhit M, Atkins T, Clark J, Scoot AM, & Glasziou P. (2023). Comparison of Telephone and Video Telehealth Consultations: Systematic Review. Journal of Medical Internet Research. 25, e49942. https://www.jmir.org/2023/1/e49942/PDF.
Center for Connected Health Policy (2024) State Telehealth Laws and Medicaid Program Policies: Fall 2024. https://www.cchpca.org/2024/11/Fall2024_ExecutiveSummaryFINAL.pdf.
Centers for Medicaid & Medicare Services. (2023). Physicians and Other Clinicians: CMS Flexibilities to Fight Covid-19. Link.
Col. Rev. Stat. § 25.5-5-320 (2024). Link.
D.C. Mun. Regs. Tit. 29 § 29-910 (2025). Link.
Del. Code 24 § 102 (2021). https://delcode.delaware.gov/title24/c060/.
Fla. Stat. 456 § 47 (2023). https://m.flsenate.gov/statutes/456.47.
Haw. Rev. Stat. § 346-59.1 (2023). Link.
HB 2028, 2017 Regular Session (Kan. 2017). https://kslegislature.gov/li_2018/b2017_18/measures/documents/hb2028_enrolled.pdf.
HB 5198, 2024 Regular Session (Conn. 2024). https://www.cga.ct.gov/2024/ACT/PA/PDF/2024PA-00110-R00HB-05198-PA.PDF.
Holcomb D, Faucher MA, Bouzid J, Quit-Bouzid M, Nelson D,B, & Duryea E. (2020). Patient Perspectives on Audio-Only Virtual Prenatal Visits Amidst the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic. Obstetrics & Gyencology. 136 (2), 317-322. https://journals.lww.com/greenjournal/.
IA Medicaid (2024) List of Approved Telehealth Services. https://hhs.iowa.gov/media/13025/download?inline.
ID Medicaid (2024) Idaho Medicaid Provider Handbook. Link.
IN Health Coverage Programs (2024) Telehealth and Virtual Services. IN Family & Social Services Administration. https://www.in.gov/medicaid/providers/files/modules/telehealth-and-virtual-services.pdf.
IN Health Coverage Programs (2025) Telehealth and Virtual Services Codes. IN Family & Social Services Administration. https://provider.indianamedicaid.com/ihcp/Publications/providerCodes/Telehealth_Services_Codes.pdf.
Kleinman RA, & Sanches M. (2022). Impacts of Eliminating Audio-Only Care on Disparities in Telehealth Accessibility. Journal of General Internal Medicine. 37(15), 4021-4023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999992/pdf/11606_2022_Article_7570.pdf.
La. Rev. Stat. 40 § 1223.3 (2024). https://www.legis.la.gov/legis/Law.aspx?d=964868.
Mass. Gen. Laws XVI § 112.50 (n.a.). https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter112/Section5O.
Medicaid (2023) AL State Plan Amendment (SPA) #: 23-0012. https://www.medicaid.gov/medicaid/spa/downloads/AL-23-0012.pdf.
Mich. Comp. Laws § 400.105h (2024). https://www.legislature.mi.gov/Home/RenderDoc?objectName=mcl-400-105h-amended.
Minn. Rev. Stat. § 62A.672 (2022). https://www.revisor.mn.gov/statutes/cite/62A.673.
Miss. Code § 83-9-351 (2023). Link.
Missouri Foundation for Health. (2020). Health Policy Solutions: Telehealth. https://mffh.org/wp-content/uploads/2020/08/Telehealth.pdf.
MO HealthNet (2022) Telehealth Services. MO Department of Social Services. Accessed February 4, 2025. Link.
Mont. Code Ann. § 53-6-155 (2023). Link.
Moran B, Frazier T, Brown LS, Case M, Polineni S, & Roy L. (2022). A Review of the Effectiveness of Audio-Only Telemedicine for Chronic Disease Management. Telemedicine and e-Health. 28(9). https://www.liebertpub.com/doi/epub/10.1089/tmj.2021.0285.
NC Medicaid (2023) Telehealth, Virtual Communications and Remote Patient Monitoring. NC Department of Health and Human Services. https://medicaid.ncdhhs.gov/1h-telehealth-virtual-communications-and-remote-patient-monitoring/open.
N.D. Cent. Code § 26.1-36-09.15 (n.a.). https://ndlegis.gov/cencode/t26-1c36.pdf.
Neb. Rev. Stat. § 71-8503 (2021). https://nebraskalegislature.gov/laws/statutes.php?statute=71-8503.
N.H. Rev. Stat. 167 § 4-d (2022). https://gc.nh.gov/rsa/html/xii/167/167-4-d.htm.
N.J. Rev. Stat 30 § 4D-6k (2024). https://law.justia.com/codes/new-jersey/title-30/section-30-4d-6k/.
N.M. Admin. Code § 8.310.2.12 (2022). https://www.law.cornell.edu/regulations/new-mexico/8-310-2-12-NMAC.
N.Y. Comp. Codes R. & Regs. Tit. 14 § 596.7 (2024). Link.
Official Code of Ga. Annotated § 33-24-56.4 (2021). Link.
Ohio Admin. Code § 5160-1-18 (2022). https://codes.ohio.gov/ohio-administrative-code/rule-5160-1-18.
Okla. Admin. Code 317 § 30-3-27 (2021). Link.
Or. Rev. Stat. § 414.723 (2024). https://oregon.public.law/statutes/ors_414.723.
PA Department of Human Services (2023) Updates to Guidelines for the Delivery of Physical Health Services via Telehealth. Link.
R.I. Gen. Laws § 27-81-3 (2021). https://webserver.rilegislature.gov/Statutes/TITLE27/27-81/27-81-3.htm.
Salisbury C, O’Cathain A, Edwards L, Thomas C, Gaunt D, Hollinghurst S, Nicholl J, Large S, Yardley L, Lewis G, Foster A, Garner K, Horspool K, Man M, Rogers A, Pope C, Dixon P, & Montgomery AA. (2016). Effectiveness of an integrated telehealth service for patients with depression: a pragmatic randomized controlled trial of a complex intervention. Lancet Psychiatry. 3, 515-525. https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)00083-3.pdf.
SB5, 2020-2021 Regular Session (Nev. 2021). https://www.leg.state.nv.us/App/NELIS/REL/81st2021/Bill/7180/Overview.
SB 534, 2023 Regular Session (Md. 2023). https://mgaleg.maryland.gov/2023RS/chapters_noln/Ch_382_sb0534T.pdf.
SC Health Connections Medicaid (2024) Updates to Telehealth Flexibilities Issued During the COVID-19 Public Health Emergency. SC Department of Health and Human Services. https://www.scdhhs.gov/communications/updates-telehealth-flexibilities-issued-during-covid-19-public-health-emergency.
S.D. Admin. Rules § 67:16:41:03 (2021). https://sdlegislature.gov/Rules/Administrative/67:16:44:01.
Tenn. Code § 56-7-1002 (2023). https://law.justia.com/codes/tennessee/title-56/chapter-7/part-10/section-56-7-1002/.
Tex. Admin. Code § 354.1432 (2023). Link.
U.S. Department of Health and Human Services. (2022). National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services. https://aspe.hhs.gov/sites/.
Utah Code 23B § 3.1.123 (2024). Link.
Va. Code § 38.2-3418.16 (2021). https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3418.16/.
Wash. Rev. Code § 74.09.325 (2022). https://app.leg.wa.gov/RCW/default.aspx?cite=74.09.325.
Wisc. Stat. § 49.45(61)(a)4 (2021). https://docs.legis.wisconsin.gov/statutes/statutes/49/iv/452.
WV Bureau for Medical Services (2022) Telehealth Services. WV Department of Health & Human Resources. Link.
**This note has been updated since its original publication. Previous versions are not up-to-date but can be found here: Version 1 (January 2024).
