State Barriers to Telehealth Access
June 3, 2026
State telehealth licensing rules often prevent patients from seeing out-of-state physicians remotely, even when patients have an existing treatment relationship or need highly specialized care. This research in brief surveys those state laws, reviews the evidence on telehealth’s effects on outcomes and access, and uses the case of rare-disease patients to show how interstate licensing barriers can disrupt continuity of care.
Key Findings:
- Every state regulates physician telehealth in some form: 8 states offer special telehealth licenses, 10 states allow registration or waiver programs, 3 states have regional reciprocity, and nearly every state recognizes at least a narrow consultation exception.
- Restrictive licensure rules are especially consequential for patients with rare or complex conditions, whose specialists are often concentrated in only a few states.
- A 2023 study of newly diagnosed cancer patients finds telehealth use was 15 percent lower in states with more restrictive licensure rules.
- Telehealth is associated with improved or comparable outcomes across multiple settings, including chronic disease management, behavioral health, maternal care, pediatric care, and rural specialty access.
- In pediatric acute care, one telehealth program reduced emergency department visits by 44 percent within 48 hours of consultation and hospital admissions by 69 percent.
- A Cigna analysis finds telehealth users had 17 percent lower total medical costs and 36 percent fewer emergency department visits than comparable in-person users.
Policy Implications:
- Although interstate compacts such as the Interstate Medical Licensure Compact are intended to streamline multistate licensing for some physicians, they do not eliminate the need to obtain separate state licenses.
- States can expand access to specialty and follow-up care by adopting broader interstate telehealth reciprocity or recognition frameworks, building on pandemic-era precedents and existing carveouts to reduce administrative barriers while preserving continuity of care across state lines.
