Medicaid RPM Coverage Across States

As of Fall 2024, 42 states now offer some form of Medicaid reimbursement for RPM, according to the Center for Connected Health Policy (CCHP). This marks an increase from 37 states in 2023, showing steady growth in Medicaid support for RPM.

Each state determines its own guidelines for RPM reimbursement, including:

• Eligibility: Which health conditions qualify for RPM (e.g., chronic conditions like hypertension or diabetes).
• Utilization: Where RPM can be used (e.g., home as the originating site).
• Restrictions: Geographic, provider, or patient requirements.
• Reimbursement Rates: How much providers will be paid for RPM services.

For example:

• States like Texas, Florida, and Virginia have broad Medicaid RPM coverage that includes chronic disease management.
• Others, such as California and Hawaii, limit reimbursement to communication technology-based services (CTBS), offering more restrictive coverage.

While this expansion reflects growing recognition of RPM’s value, not all states cover RPM services or have clear reimbursement policies.

COVID-19’s Impact on Medicaid RPM Policies

In response to the COVID-19 pandemic, many states temporarily loosened Medicaid telehealth and RPM policies to improve access to care while minimizing in-person visits. Key temporary changes included:

• Expanding the types of services eligible for RPM.
• Allowing verbal consent in place of written consent for RPM enrollment.
• Removing geographic restrictions, allowing the home to serve as the originating site.
• Waiving requirements for in-person patient-provider relationships before RPM enrollment.

Some of these policies have been made permanent, while others were rolled back as emergency measures ended. For the most current information, check your state’s Medicaid telehealth policies via the CCHP website.

Which States Cover RPM Under Medicaid?

The following states offer some form of Medicaid reimbursement for RPM as of Fall 2024 (* indicates states where RPM coverage is limited to CTBS):

States with Medicaid RPM Reimbursement:

• Alabama
• Alaska
• Arizona
• Arkansas
• California*
• Colorado
• Delaware
• Florida
• Hawaii*
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts*
• Michigan
• Minnesota
• Mississippi
• Missouri
• Nebraska
• New Hampshire
• New Jersey
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• South Carolina
• South Dakota
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia*
• Wisconsin

Some states not listed above may have legislation requiring Medicaid coverage of RPM but lack clear policies for implementation. Providers should refer to their state Medicaid offices for the most up-to-date details.

Key Medicaid Requirements for RPM Reimbursement

To bill Medicaid for RPM services, providers must meet state-specific requirements. However, many Medicaid programs share the following common guidelines:

• FDA-Approved Devices: RPM devices must meet the FDA’s definition of a medical device.
• Patient Consent: Patients must opt into RPM services, typically with written or verbal consent.
• Data Use: Collected data must be transmitted securely and in compliance with HIPAA regulations.
• Chronic Condition Management: Medicaid often limits RPM coverage to chronic diseases like diabetes, COPD, or hypertension.
• Time Requirements: Some states may enforce specific time or usage thresholds for RPM reimbursement, similar to Medicare’s 16-day rule.

Providers should consult their state Medicaid guidelines to ensure compliance with local policies.

Why Medicaid RPM Matters

For Medicaid patients, RPM provides a lifeline to better manage chronic conditions, reduce complications, and stay healthier between visits. Medicaid beneficiaries, who are more likely to have chronic illnesses, stand to benefit the most from continuous monitoring.

For providers, Medicaid RPM reimbursement offers an opportunity to:

• Improve care for underserved populations.
• Generate revenue by integrating RPM into chronic care management programs.
• Reduce emergency visits and hospitalizations, easing the strain on healthcare systems.

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