Telemedicine is an important capacity-building service that is of particular benefit in geographic ar­eas where pediatric subspecialty care is unavailable or difficult to access. A growing number of states make extensive use of telemedicine.

Louisiana Medicaid requires their Managed Care Organizations’ (MCO) networks to include, among other types of providers, a children’s hospital and pediatric specialists that meet certain requirements. If members do not have access to at least one of the specialty providers within 90 miles of their homes, or the provider is not included in the network, the MCO must provide access via other means, such as through telemedicine.

Mississippi covers and reimburses for telemedicine services throughout the state for enrolled Medicaid providers, including services provided at health centers and by school nurses for children enrolled in Medicaid. This ensures access to care in rural parts of the state, minimizes travel time, and provides care in settings where children are more comfortable.

Montana is primarily a frontier state. In order to ensure children’s timely access to screening and care, the Montana Medicaid program uses a screening team model to link providers across various locations via iPads and reimburses for telehealth visits for children enrolled in Medicaid. For example, the Fort Peck Tribe in the remote northeast corner of the state teams school nurses with nurse practitioners, both located on the reservation, but 55 miles apart.  If the school nurse is concerned about a child, he or she uses the iPad to connect with a nurse practitioner for additional consultation, and Montana Medicaid reimburses for this telehealth visit. This Tribal community has also placed a dental chair in one of the schools, which is staffed by a dental hygienist so children can receive dental cleanings and screening exams. There is also a mental health practitioner at the school. Medicaid pays the Tribe for telehealth and direct services for any child who is eligible for Medicaid. An additional bonus to this arrangement is children no longer miss school and parents no longer miss work to travel all day to seek care.