Yes—Medicaid covers telehealth in rural America. But what you can use (video, audio-only, remote monitoring), where you can be (often home), and which providers qualify depend on your state. Below is a plain-English map to what’s covered in 2025—and how to get connected even if your internet or provider options are limited. Medicaid+1

Quick answer: Does Medicaid cover rural telehealth in 2025?

Short version: Yes, in every state—but rules differ by state. Most states now cover video and audio-only visits, often allow the home as the site of care, and increasingly cover remote patient monitoring (RPM) and some store-and-forward (asynchronous) services. Always check your state’s specifics (link below). Source: HHS Telehealth (state Medicaid), CMS Toolkits; last checked: Sep 11, 2025. telehealth.hhs.gov+1

Bottom line: Medicaid telehealth is real and usable in rural areas—you just need to confirm your state’s rules and your plan’s network.

What Medicaid telehealth covers (and why it varies by state)

Medicaid is federal-state. CMS sets the guardrails, but states decide which telehealth modalities, provider types, and sites they’ll cover and how they’ll pay. CMS’s Telehealth Toolkit (Feb 2024) and reimbursement guidance confirm that states can pay both the distant practitioner and (when applicable) an originating site facility fee. Medicaid+1

Common covered modalities in 2025

• Live video visits (primary care, behavioral health, some specialty care).
• Audio-only visits (especially behavioral health), often with guardrails (e.g., when video is unavailable). telehealth.hhs.gov
• Remote patient monitoring (RPM) for certain chronic conditions (device + data + monthly check-ins). Medicaid
• Asynchronous (store-and-forward) services in some states (e.g., photo or data review before a follow-up). telehealth.hhs.gov
• Home as originating site in many states—no need to travel to a clinic just to connect by video. telehealth.hhs.gov

Behavioral health is the core use case. States widely kept pandemic-era expansions for mental health and SUD services, with many allowing audio-only when video isn’t feasible. KFF

Safety-net clinics (FQHCs/RHCs). States generally may reimburse FQHCs and RHCs for Medicaid telehealth—details are state-specific, but federal guidance encourages flexible payment approaches. (Medicare rules differ and are time-limited for some services through Sept 30, 2025, but Medicaid policy is state-driven.) Source: CMS Medicaid telehealth reimbursement; HHS Telehealth policy updates (context). Medicaid+1

Bottom line: Expect video + audio-only options at home; check your state Medicaid site (and your plan) for RPM/asynchronous details. telehealth.hhs.gov

Broadband reality after ACP (and how to connect anyway)

The Affordable Connectivity Program ended on June 1, 2024, so that $30–$75 monthly internet subsidy is gone for most households. That hit rural Medicaid families hardest. But you still have options: Federal Communications Commission

Low-cost connection checklist

1. Apply for FCC Lifeline: Up to $9.25/mo off phone or internet; up to $34.25/mo on Tribal lands. Check eligibility via the National Verifier. Source: FCC Lifeline, last checked: Sep 11, 2025. Federal Communications Commission+1
2. Ask your clinic about “virtual visit rooms”: Many FQHCs/RHCs set up private telehealth rooms or loaner devices—often funded by USDA DLT grants. Source: USDA DLT program, FY25 materials. Rural Development+1
3. Use community hotspots: Libraries, schools, and county health departments commonly offer Wi-Fi/private booths for telehealth.
4. Monitor state BEAD updates: BEAD is funding rural broadband but some states are revising timelines under new 2025 guidance. See NTIA’s BEAD progress dashboard for your state. Source: NTIA, June–Sept 2025. NADO+1

Bottom line: Lifeline + clinic telehealth rooms + community Wi-Fi can bridge the gap today while BEAD buildouts proceed. Federal Communications Commission+1

Crossing state lines: licensure & compacts (in plain English)

Rule of thumb: In telehealth, the visit happens where the patient is. Your clinician usually must be licensed in your state (and in your Medicaid plan network if you’re in managed care). telehealth.hhs.gov

What helps in 2025:

• IMLC (physicians): Dozens of states use the Interstate Medical Licensure Compact to speed licensure across states—helpful for multi-state systems serving rural borders. Check your state’s status. Interstate Medical Licensure Compact
• PSYPACT (psychologists): Many states now let licensed psychologists practice telepsychology across member states via PSYPACT. psypact.gov
• Counseling Compact (LPCs): Issuing privileges began in 2025 in participating states, expanding cross-border tele-counseling access. counselingcompact.gov
• Nurse Licensure Compact (RNs/LPNs): Broad multistate recognition for nursing practice, important for care management and tele-triage. See NCSBN map. NCSBN

Mini flow:
If your preferred clinician is in another state → confirm licensure (or compact privilege) and your plan’s network rules; if not, ask your plan for an in-network telehealth option or an out-of-network exception (e.g., no local specialist).

Bottom line: Compacts expand access, but plan networks still matter—call the number on your Medicaid card before booking. telehealth.hhs.gov

Behavioral health & SUD by telehealth in 2025

• Audio-only allowed (often): Many states permanently allow audio-only telehealth for behavioral health when video isn’t possible. State specifics vary. KFF
• SUD prescribing via telemedicine: **DEA/HHS extended COVID-era telemedicine flexibilities through Dec 31, 2025 while final rules are pending—critical for rural buprenorphine access. Source: DEA/HHS announcements. DEA+1
• Clinic types: FQHCs, RHCs, CCBHCs and community mental health centers increasingly deliver virtual therapy, MAT follow-ups, group visits under state Medicaid. (Payment models vary by state.) Medicaid

Bottom line: Behavioral health remains the most accessible Medicaid telehealth service in rural America—including audio-only and SUD care under 2025 DEA extensions. KFF+1

Privacy, language access, and accessibility

• HIPAA: The OCR telehealth enforcement discretion ended in 2023. Providers must use HIPAA-compliant platforms and follow privacy rules (and avoid unlawful tracking tech)—ask your clinic which app they use. Source: HHS OCR, last checked: Sep 11, 2025. HHS.gov+1
• Language & disability access: Section 1557 rules require nondiscrimination—clinics should offer qualified interpreters, captions, screen-reader-friendly portals, and accessible formats for people with disabilities. Source: HHS 1557 final rule (2024). HHS.gov

Bottom line: You can request interpreters, captions, and accessible tech for Medicaid telehealth—it’s your right. HHS.gov

How to check your state’s Medicaid telehealth rules (and book)

1. Look up your state’s policy: Use HHS’s state Medicaid telehealth coverage page (updated Jan 17, 2025) → follow links to your state Medicaid site. telehealth.hhs.gov
2. Confirm your plan benefits: If you’re in Medicaid managed care, call the number on your card or check your member portal.
3. Pick a setting:
   • Home/phone (if allowed)
   • Clinic telehealth room (FQHC/RHC)
   • Community hotspot (library/school)
4. Prepare for the visit: Charge device, close unused apps, find good light, have med list handy, and, if needed, request an interpreter in advance.

Bottom line: Start at HHS Telehealth → your state policy → confirm with your plan → choose a connection that works today. telehealth.hhs.gov

Rural Medicaid telehealth: common roadblocks + fixes

• No broadband or data plan: Use Lifeline, ask about loaner devices/clinic pods, or choose audio-only if covered. Federal Communications Commission
• No private space: Book a telehealth room at your clinic/library; many are grant-funded (e.g., USDA DLT). Rural Development
• Cross-state specialist: Ask if they hold IMLC/PSYPACT privileges and if your plan will cover. Interstate Medical Licensure Compact+1
• Behavioral health meds: Confirm DEA telemedicine flexibilities (through 2025) and your state’s prescribing rules. DEA
• Privacy worries: Ask for a HIPAA-compliant platform and a no-tracking patient portal. HHS.gov+1

Bottom line: There’s almost always a workable path—even without home internet.

Comparison table: Telehealth options for rural Medicaid members (2025)

Modality	Common Medicaid Coverage (state-specific)	Rural Pros	Typical Limits/Notes
Live video	Widely covered for primary, specialty, BH	Closest to in-person; home often allowed	Requires bandwidth/device; consent/tech literacy vary. telehealth.hhs.gov
Audio-only	Frequently covered for BH; mixed for other care	Works on basic phones; low bandwidth	Often allowed only when video unavailable or for select services. KFF
RPM	Increasingly covered for chronic conditions	Continuous data enables proactive care	Device criteria + diagnosis limits; monthly engagement required. Medicaid
Asynchronous	Covered in some states	Good for dermatology, follow-ups	Not universal; payer documentation rules apply. telehealth.hhs.gov
Clinic telehealth room	Typically covered as in-person/telehealth hybrid	Private space, strong connection	Travel to clinic; site fees vary by state. Medicaid

Eligibility checklist: “Can I use telehealth on Medicaid where I live?”

• I’m enrolled in Medicaid or CHIP (managed care or fee-for-service).
• My state Medicaid allows home telehealth for my service type. telehealth.hhs.gov
• If I can’t do video, my state covers audio-only (especially for BH). KFF
• If my clinician is out of state, they hold licensure/compact privileges in my state and are in-network (or I have an exception). Interstate Medical Licensure Compact+1
• If I need SUD meds, telemedicine prescribing is permitted under the DEA extension through Dec 31, 2025. DEA
• If I lack internet, I’ve checked Lifeline/community options. Federal Communications Commission

Bottom line: If most boxes are checked, you can likely book telehealth now. Confirm details with your plan.

Sensitive facts & sources (placed near key claims)

• State coverage varies; home, audio-only, RPM, asynchronous often allowed: Source: HHS Telehealth (state Medicaid), last checked: Sep 11, 2025. telehealth.hhs.gov
• CMS Telehealth Toolkit & reimbursement flexibility: Source: CMS (Feb 2024 Toolkit; reimbursement page), last checked: Sep 11, 2025. Medicaid+1
• Rural Medicaid reliance (~1 in 4): Source: KFF (Jun 26, 2025), last checked: Sep 11, 2025. KFF
• DEA telemedicine extension through Dec 31, 2025: Source: DEA/HHS, last checked: Sep 11, 2025. DEA
• ACP end date & Lifeline amounts: Source: FCC (ACP & Lifeline), last checked: Sep 11, 2025. Federal Communications Commission+1
• BEAD status & state timelines: Source: NTIA (Policy Notice/dashboard), last checked: Sep 11, 2025. NADO+1
• HIPAA & telehealth privacy: Source: HHS OCR, last checked: Sep 11, 2025. HHS.gov

Disclaimer: This guide is educational and not legal/medical advice. Medicaid rules differ by state and plan; verify with your state Medicaid agency and plan.

Takeaways & next steps

Takeaways (3–5):

1. Medicaid telehealth works in rural areas, but the details are state-specific—home site, audio-only, RPM, asynchronous. telehealth.hhs.gov
2. Behavioral health leads telehealth access; many states permanently allow audio-only. KFF
3. DEA telemedicine rules for controlled meds are extended through 2025, sustaining rural SUD access. DEA
4. With ACP gone, use Lifeline, clinic pods, and community Wi-Fi while BEAD buildouts continue. Federal Communications Commission+2Federal Communications Commission+2
5. Compacts (IMLC, PSYPACT, Counseling) help cross-state access, but plan networks still govern coverage. Interstate Medical Licensure Compact+2psypact.gov+2

Next steps:

• Check your state’s Medicaid telehealth policy on HHS Telehealth; confirm with your plan. telehealth.hhs.gov
• If connectivity is the issue, apply for Lifeline and ask your clinic/FQHC about telehealth rooms or devices. Federal Communications Commission
• For behavioral health or SUD, ask providers about audio-only options and tele-MAT availability under current DEA rules. DEA
• If crossing state lines, verify licensure/compact and network status before scheduling. Interstate Medical Licensure Compact

FAQ Section

1) Does Medicaid cover audio-only telehealth if I don’t have video?
Often yes, especially for behavioral health, but rules vary by state. Check your state Medicaid policy and your plan’s benefits. KFF+1

2) Can I do a telehealth visit from home on Medicaid?
In many states, home is an approved site for Medicaid telehealth—confirm for your state and service type. telehealth.hhs.gov

3) I live near the state line. Can my doctor in another state see me by telehealth?
Usually only if they’re licensed in your state (or have a compact privilege) and your plan covers them. telehealth.hhs.gov

4) Will telehealth cover my mental health or addiction care?
In most states, yes—and many permit audio-only. DEA telemedicine flexibilities for controlled meds are extended through Dec 31, 2025. KFF+1

5) ACP ended—how can I afford internet for telehealth?
Apply for FCC Lifeline (up to $9.25/mo; $34.25 Tribal), ask clinics about telehealth rooms or device loans, and use community Wi-Fi. Federal Communications Commission

6) Is telehealth private and secure?
Yes—providers must use HIPAA-compliant platforms after 2023. You can also request interpreters, captions, and accessible tech under Section 1557. HHS.gov+1

7) Where do I find my state’s exact rules?
Start at HHS Telehealth’s state Medicaid coverage page and follow the link to your state Medicaid site. telehealth.hhs.gov

8) Do FQHCs and RHCs do telehealth for Medicaid?
Yes in many states—payment details vary. Ask your local clinic; CMS encourages flexible state reimbursement. Medicaid