Document Type
Article
Publication Date
Fall 2025
Abstract
This article examines the historical development, regulatory landscape, and post-pandemic future of telehealth in the United States, with a particular focus on its original purpose: improving access to care for rural populations. Although Congress first authorized Medicare reimbursement for telehealth in 1997 to alleviate rural health disparities, federal and state regulatory frameworks—especially restrictions on originating sites, licensure rules, and HIPAA-driven technology requirements—significantly limited adoption for more than two decades. The COVID-19 public health emergency triggered sweeping temporary waivers that removed geographic limitations, permitted the use of common communication technologies, liberalized supervision and prescribing rules, and allowed audio-only encounters. These changes produced an unprecedented surge in telehealth utilization, though disproportionately in urban rather than rural communities. The article analyzes emerging data showing that telehealth growth in rural areas has lagged behind urban uptake, raising concerns that universal post-pandemic expansion could exacerbate access disparities rather than resolve them—especially in mental health care, where telehealth usage is highest and rural shortages are most acute. After reviewing recent federal and state legislative efforts and private-sector trends, the article argues that telehealth policy must include targeted rural incentives—rather than broad, universal reforms—to avoid widening the rural–urban care gap. It concludes with recommendations for regulatory and financial strategies to ensure that telehealth serves as a genuine access equalizer for rural patients rather than a new frontier of health inequity.
Recommended Citation
Deborah R. Farringer, Bridging the Rural Telehealth Divide, 78 Okla. L. Rev. 55 (2025)
