Expiration of Pandemic-Authorized License Waivers Raises Questions for Out-of-State Clinician Care

Typically, physicians must hold a license in the state where their patients are located. However, at the start of the covid-19 pandemic, most states implemented temporary license waivers, allowing patients to obtain care from out-of state clinicians via telemedicine.

While these licensure waivers were active, there was a surge of out-of-state telemedicine visits surged. However, what happens when those waivers expire?

This was the question addressed in a recent study in JAMA Open Network led by Eric Bressman at the University of Pennsylvania which included Professor of Health Care Policy Ateev Mehrotra and graduate student Benjamin Barsky, and coauthors.

The study describes how the waiver expirations drove many patients to stop seeing their out-of-state physicians. The results support the need to reform state licensure in order to avoid any breaks in patients’ access and treatment.

The study used Elevance health claims data spanning from January 2019 through June 2022, focusing on patients in states where licensure waivers for out-of-state telemedicine expired (Colorado, Maine, Wisconsin) versus states where waivers continued (California, Indiana, New Hampshire, New York) until mid-2022.

There were 45,087 unique patients and 55,845 out of state telemedicine relationships prior to the waivers. Post waiver expiration, patients in states where the waivers expired earlier were less likely to have any visits, particularly when the patient-clinician distance was higher.