Starting this week, Kentuckians with Medicaid coverage can start seeing their doctor through their phone.
A state law passed in 2018 allows a patient to stay in their home and have a doctor’s visit using a special medical video platform. The providers have to be licensed in Kentucky, but no longer have to be licensed through a telehealth board.
Robert Caudill is a psychiatry professor at the University of Louisville. He sees patients who drive long distances to the university for care.
“In reality, what we’re looking at is sort of a return to house calls,” Caudill said. “So I think what will happen is something called a hybrid practice, and that’s where a patient might come into our office and be seen in person for an initial visit. And then they’re offered sort of the opportunity on the return visit, do you want to come in and see us in person?”
Caudill said the new program will be helpful for mental health conditions, but also for physical health conditions like colds or acne.
To schedule a visit, a patient would still go through their provider to find out if telehealth is offered.
The law also applies to commercial insurers, though many of those already offer telemedicine through services like Doctor on Demand.
Health providers, however, might be slow to pick up the practice. Caudill already sees patients in rural areas, but those patients must drive to a specially-credentialed rural clinics to connect via video — they can’t stay home. Now, patients will technically be able to see him virtually and not have to drive to a facility. But Caudill said telemedicine will not replace these rural clinics.
“If we were to sort of bypass these clinics and just start seeing the patients directly in their home, it potentially takes these clinics out of the loop,” Caudill said. “The brick and mortar presence in these rural communities is not negligible. It’s not unimportant. It’s something I would like to see the telehealth services augment and not replace.”
He says telehealth will also be helpful to people who might be home-bound and not currently getting care.
“I think there’s an untapped population of folks who have never probably received services properly,” Caudill said. “And we don’t know about them, because they don’t come in. But I would hope this would be the sort of thing that could provide them with some access.”
To be seen at home, patients will have to have internet access at home, which could present problems.
The legislation also does something else: it now allows lower-level providers like nurse practitioners or psychologists to see patients via telemedicine.
That’s important because in Kentucky, there are not enough mental health providers. In 2013, Kentucky faced a shortage of 1,638 mental health providers to keep up with demand, according to a state report. The report also said that rural counties were most in need of mental health providers, and that there were more clinical social workers and psychologists than any other mental health professionals in the state.
Kentucky’s Cabinet of Health and Family Services is working on a website and literature to help educate Medicaid enrollees about their options.