From Expansion to Expiration: Federal Policy Waivers and Telehealth Utilization in US Primary Care (2016-2024).

Abstract

Background: The use of Telehealth has fluctuated over the past 8 years, with events such as the COVID-19 pandemic driving considerable growth in usage. During the COVID-19 pandemic, federal policy waivers were enacted to have Medicare cover costs for synchronous telehealth visits, increasing accessibility to telehealth during a public health emergency. Although waivers temporarily expanded access, sustainable, equitable telehealth access continues to heavily depend on overlooked factors such as technological accessibility, broadband availability, disability accommodations, and insurance status, particularly in rural and underserved populations. With these federal waivers set to expire on December 31, 2025, it is critical to evaluate the effectiveness and long-term impact of such federal policy waivers and to determine whether these have meaningfully improved telehealth access or have merely delayed underlying inequities.

Methods: In this scoping review, the authors aimed to evaluate the impact of federal policy waivers on the utilization of synchronous telehealth with a focus on primary care across the United States from 2016 to 2024. Database searches across PubMed, SCOPUS, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO yielded 137 unique references. Two screening stages resulted in 19 articles that met all evaluation criteria for review inclusion.

Results: A review of the existing literature showed a common theme, in that federal waivers primarily affected telehealth usage by altering key social determinants of health and structural accessibility-driving both overuse in some populations and underuse in others. The most significant impact of the waivers was removal of geographic restrictions, particularly benefiting disadvantaged and rural communities. Studies noted that following the expiration of the waivers, patients-especially those seeking care across state lines-were less likely to attend either telemedicine or in-person visits, highlighting an immediate reduction in care access.

Conclusions: Overall, previous studies have emphasized that sustaining telehealth access depends less on awareness efforts and more on addressing implementation barriers, particularly for nonambulatory, transportation-dependent, and financially disadvantaged populations.