After the Senate on Friday blocked a House-passed short-term government funding bill, the threat increased for a government shutdown on Oct. 1. Caught in the crossfires is the future of Medicare coverage for telehealth services.
The temporary Medicare telehealth rules that have been in place since March of 2020 are set to expire at the end of September unless Congress passes new legislation to extend them or make them permanent. If they expire, Medicare patients may lose access to some of the telehealth services they’ve relied on for the past few years.
Right now, Medicare patients can do virtual visits from their homes. Without the extension, they’d usually have to go to a designated medical facility-like a clinic or hospital- to use telehealth, which defeats much of the convenience. Many of the extra services that Medicare started covering virtually during COVID, like certain behavioral health care, physical therapy, or chronic disease management, would no longer be covered if delivered by telehealth.
Medicare has been covering some visits by phone which is helpful for patients without internet or video capability. That coverage could go away, cutting off access for people in rural or low-tech situations. The special allowance for mental health and substance use treatment by telehealth could scale back, creating a barrier at a time when demand for these services is high.
As of 2024, there were 672,118 people in South Carolina on traditional Medicare, according to the Kaiser Family Foundation, so while some of those people may be enrolled in Medicare Shared Savings Plans (MSSPs) or Accountable Care Organizations (ACOs), that is roughly the number of people in SC whose access would be decreased if the flexibilities expire.
Sonya Ebeling is the Director of the South Carolina Telehealth Alliance. She said only people with traditional, fee-for-service Medicare would be impacted if these flexibilities expire.
“It is important to note that people with South Carolina Medicaid or private insurance will not be impacted by this change and can continue to receive services via telehealth, per the coverage policies of their insurance company,” Ebeling said.
Telehealth use has grown exponentially since the pandemic. According to Ebeling, overall visits in 2019- not specific to any one payer- were about 15,000 ambulatory telehealth visits in South Carolina compared to 2020 when that number jumped to 1.2 million.
In 2024, the SCTA reported over 676,000 ambulatory telehealth visits in South Carolina, the majority of which are “direct-to-consumer” visits to patients in their homes (not payer-specific).
Because of the political climate in Washington D.C., it is unclear how soon a continuing resolution could be agreed on that will extend government funding and ensure Medicare coverage for certain telehealth flexibilities. However, telehealth does have support from both sides of the political aisle.
“Telehealth is a bipartisan issue with support from both Republicans and Democrats,” Ebeling said. “The South Carolina delegation has been very supportive of making these flexibilities permanent, particularly Senator Tim Scott, who has introduced the Telehealth Modernization Act companion bill in the Senate several times. If Congress can pass a continuing resolution before the deadline, telehealth extensions will be included in that package. They just have to do it.”
The SCTA along with other telehealth stakeholders including The American Telemedicine Association, are pushing for a permanent solution that would free Medicare telehealth coverage from this recurring threat.
Kyle Zebley is executive director of ATA Action, the advocacy arm of the ATA. He said in a statement this week that the ATA supports and endorses a short-term continuing resolution but the organization will continue to push for permanently allowing access to these services for Medicare recipients.
“Under President Trump’s transformative leadership during the pandemic, essential flexibilities were enacted to allow unprecedented access to telehealth that has since proved indispensable to our healthcare system,” Zebley said. “President Trump can now take another courageous step to stop this endless loop of uncertainty and secure permanent access to telehealth services.”
Congress is in recess this week, and they do not return to session until September 29.
