Dr. Stephen Robinson has a telehealth appointment with a patient at M Health Fairview Clinic in Prior Lake, Minn., on Oct. 2, 2024. (Renée Jones Schneider/The Minnesota Star Tribune)

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Addyson Moore of Kenyon, Minn., says that telehealth appointments have been a “lifesaver.”

As a mom with a special-needs daughter living in rural Minnesota, distance and demands on Moore’s time pose challenges for her to get the mental health care she needs to meet her parental responsibilities. Since the COVID-19 pandemic, many of her appointments have been done virtually, via video or audio-only on her phone, overcoming these barriers. Moore, 28, can talk with her therapist or see a psychiatrist or other specialists without driving an hour or more to a clinic, which also benefits the family budget.

Without telehealth, Moore worries that “I wouldn’t be getting that care at all,” especially when her daughter requires hospital stays.

She understandably doesn’t want to lose the convenience and savings. Unfortunately, without swift action at the state and federal levels to extend pandemic-era telehealth flexibilities, patients like her in Minnesota and elsewhere could soon see their options significantly restricted.

The federal rollback of telehealth choices for patients covered by Medicare, which mainly serves those 65 and up, is currently set for March 31. Without congressional action, pre-pandemic policies will go into effect this spring, causing what the American Hospital Association is calling a “telehealth cliff" for the 68 million Americans relying on Medicare.

Among the changes:

Geographic limitations on patient eligibility for telehealth visits.
Restrictions on the types of providers allowed to perform telehealth.
Requiring telehealth patients to use audio-visual technology instead of allowing “audio-only” (think traditional phone call here).
Requiring an in-person evaluation before telehealth appointments for mental health care, and annual in-person visits.
No longer allowing virtual supervision of some telehealth providers and instead requiring “immediate in-person availability,” which could make it more difficult to access care for cardiac or pulmonary rehabilitation.

The state-level rollback of expanded state-level telehealth flexibilities would involve the nearly 1.3 million Minnesotans who rely on Medical Assistance or MinnesotaCare, two publicly funded programs for low-income Minnesotans. It would end “audio-only” telehealth access, meaning those who currently seek this care through a regular phone call would now have to switch to an audiovisual technology such as FaceTime on Apple phones or Zoom on computers.

While the policy may not seem problematic at first glance, it’s a big deal for those who don’t have a smartphone or aren’t tech-savvy.

“There’s a huge population that does not have these resources,” said Beth Rader, the site treatment director for Productive Alternatives CSU, an organization based in Fergus Falls, Minn., that provides mental health crisis stabilization care.

Rader said the audio-only option is important for clients who are battling mental illness and, often, other health or financial problems. The option that may work best for them: just taking the organization’s cordless landline phone into a private room to get the care they need.

Moore, the young mom from Kenyon, is a Medical Assistance enrollee. She also said that the audio-only option helps ensure she can access vital care.

The state policy that allows the audio-only option expires at the end of June. Gov. Tim Walz is commendably pushing to extend it through June 2027. Legislators should have enough time this session to act. But lawmakers also have a crowded agenda and got off to a late start.

Thankfully, legislators leading and serving on a key health policy committee, such as Rep. Jeff Backer, R-Browns Valley, and Rep. Robert Bierman, DFL-Apple Valley, told me that they have this issue on their radar. That’s reassuring, but there’s work to do.

Extending telehealth capabilities at the state and federal levels has the support of the region’s leading medical organizations. Among them: the Minnesota Medical Association and the Minnesota Hospital Association, which noted a study released by the Minnesota Department of Health in September. It found that telehealth expanded care access without boosting health care spending.

Regional providers also note the importance of telehealth, particularly for rural residents. Dr. David Newman, who serves as Sanford Health’s chief medical officer for virtual care, said that 20% of Sanford’s behavioral health patients use telemedicine and that 78 specialties within Sanford’s system provide care this way.

Newman argues that in an era when Amazon delivers goods to your doorstep, patients understandably expect similar capabilities for other services. Leveraging technology does this, he said, and the nation should be making telehealth options permanent instead of going backward.

In his view, patients won’t just substitute a clinic appointment if they can’t do telehealth. “If they don’t get care virtually, they won’t get care at all,” he said, a setback for those with diabetes and other conditions requiring careful management.

Minnesota’s U.S. senators, Amy Klobuchar and Tina Smith, have strongly advocated for the federal telehealth extension. They’ll need to muster all their influence. One opponent so far has been Elon Musk, the billionaire turned government cost-cutter.

While he hasn’t specifically objected to telehealth, Musk’s opposition helped tank a bipartisan end-of-year congressional spending package. It contained a telehealth extension through 2026.

Musk likely won’t be a fan of telehealth’s cost. The Congressional Budget Office put the price of a two-year federal telehealth extension at $4 billion. The cost of the Minnesota audio-only extension: $19.3 million for the next fiscal year.

Those figures bear scrutiny as the extensions are weighed. Do the calculations reflect the cost of the technology, or is it that patients who would have forgone care without this option will now be getting it via telehealth? If it’s the latter, which appears to be the case for the state telehealth option, then policymakers should prioritize care access, which may deliver preventive savings, such as keeping people from becoming seriously ill and needing expensive hospitalization.

To put a finer point on this, policymakers and cost-cutters like Musk should be looking at telehealth’s return on investment, not just looking at the price tag and saying no.