The State of Telehealth Policy: January 2026
Accessing healthcare in the United States is not always straightforward. Some regions lack enough providers, and illness or circumstance can make it difficult to attend in-person appointments even where providers are available. Expanding avenues for remote healthcare provision helps minimize some of these challenges. Telehealth—using technology to provide or support care when patients and providers are not together in person, including video and audio-only visits as well as asynchronous communication and assessment—is one innovation to improve access.
Care delivery via telehealth was uncommon prior to the COVID-19 pandemic, which changed the healthcare landscape in many ways. Although telehealth utilization has decreased and stabilized, it still remains above pre-pandemic levels. Its continued use is unsurprising, as patients and providers alike find telehealth highly acceptable, cost-effective, and successful in improving patient outcomes. Nevertheless, policies that enable this treatment modality remain in flux.
Two Policy Conversations
Two different conversations are affecting telehealth policy today. The first relates to providers’ ability to prescribe controlled substances—medications classified as Schedule II-V by the Drug Enforcement Administration (DEA)—via telehealth without a prior in-person visit. Pandemic-era flexibilities enabled providers to prescribe certain drugs, including stimulants used to treat attention-deficit hyperactivity disorder, buprenorphine for opioid use disorder (OUD), and benzodiazepines for anxiety without an in-person exam. These permissions were set to expire at the end of 2025; however, the Department of Health and Human Services (HHS) and the DEA have extended them through Dec. 31, 2026, giving the agencies time to finalize permanent rules on the teleprescription of controlled substances. The extension also staves off the “impending telemedicine cliff” that likely would have disrupted care for many patients and created confusion among healthcare providers.
The second conversation revolves around whether to extend Medicare coverage for telehealth visits. Medicare is a major health insurer, covering about 62.8 million Americans. But while the Centers for Medicare & Medicaid Services has significantly expanded its coverage of telehealth services since the pandemic, Medicare telehealth flexibilities expired in October 2025—and the bill extending them does so only through Jan. 30, 2026. More than one in 10 Medicare beneficiaries currently use telehealth, and many of them could lose access to these services if Congress does not take action before the deadline.
Groups Most Likely Affected
Several patient groups will likely experience a greater impact if these telehealth flexibilities are not extended permanently. The first is older Americans, as people 65 and older make up the vast majority of Medicare beneficiaries and may have the highest rates of telehealth use. According to the most recent data, Medicare pays for about a quarter of telehealth visits. This means older Americans could experience disruptions in care if Congress does not act swiftly.
People taking medications for mental health conditions are also likely to be affected. Telehealth utilization for mental health treatment is much higher than for other specialties, with about 28 percent of encounters utilizing telehealth. In fact, mental-telehealth utilization is 2.8 times higher than the next highest specialty (endocrinology), although not all mental health appointments involve prescribing controlled substances. Still, it is likely that patients using controlled substances to manage mental health conditions could find it harder to access their medications if HHS and the DEA do not finalize permanent telehealth prescribing rules that do not require in-person assessments.
Similarly, should favorable permanent rules not materialize by the end of 2026, people taking buprenorphine to treat OUD could encounter challenges with continuity of care. The current proposed rules dial back the ability to initiate patients on buprenorphine for OUD by requiring patients who receive the prescription via telehealth to see their provider in person within 30 days. Research suggests this change would have prohibited 20 percent of the 22,601 telehealth-initiated buprenorphine prescriptions for OUD. This is particularly concerning because telehealth initiation of buprenorphine is associated with greater treatment engagement and lower overdose rates than in-person initiation.
Patients living in rural areas may also experience outsized impacts if required to visit a provider in person to receive their medications. Since 75 percent of rural counties have no mental health providers (or fewer than 50 per 100,000 residents), rural residents are especially likely to struggle to meet the in-person requirement. In the case of OUD, 62 percent of counties with the highest OUD rates are considered rural, proving that in-person prescribing requirements could be especially harmful for rural residents.
Need for Permanent Telehealth Flexibilities
Ensuring continuous healthcare access is vital to improving health outcomes. The pandemic offered a grand experiment in expanding telehealth access, proving that telehealth is an acceptable and feasible way to deliver many forms of healthcare—in fact, technology-mediated care was one of the few positive things to come out of it. Allowing telehealth flexibilities to lapse or placing greater restrictions on access could disrupt care for many patients, sometimes with tragic results.