Bridging the digital divide: Telehealth’s growing impact on healthcare access in Michigan

Virtual health care has emerged as a lifeline for many low-income adults in Michigan, particularly those enrolled in Medicaid. A growing body of evidence, including a recent study from the University of Michigan (U-M), shows that telehealth is bridging long-standing gaps in access to medical care.

Whether through video calls or telephone appointments, telehealth is reshaping how health services are delivered and accessed, especially for individuals facing systemic barriers such as transportation issues, time constraints, or internet challenges.

Addressing barriers through technology

The Healthy Michigan Plan, Michigan’s Medicaid expansion program, serves more than 725,000 residents between the ages of 18 and 64. It targets individuals earning up to 133% of the federal poverty level—roughly $20,000 a year for a single person. As part of the official evaluation of this plan, researchers at U-M’s Institute for Healthcare Policy and Innovation (IHPI) analyzed responses from 4,082 enrollees gathered between 2021 and 2022.

Their findings reveal that 30% of respondents used telehealth services in the past year. While this figure might seem modest at first glance, it reflects a significant uptake among a population that often lacks reliable access to traditional health care settings. Of those who used telehealth, about two-thirds accessed care through video visits, while the remainder relied on phone calls.

Breaking down access barriers

One of the key findings from the U-M study is how telehealth has enabled individuals to receive care they likely would have foregone otherwise. About 63% of telehealth users reported that their virtual appointment provided medical attention they wouldn’t have received in person due to logistical challenges.

Barriers to care cited in the study include difficulties scheduling in-person visits, transportation limitations, the inability to take time off work, and caregiving responsibilities. These challenges are particularly relevant to Medicaid enrollees, many of whom are juggling jobs with irregular hours, multiple family obligations, and financial constraints.

People who had a primary care provider but still faced obstacles accessing care were more likely to turn to telehealth—43% of them reported having a virtual appointment, compared to 33% of those without such barriers.

Digital divide: Telehealth access challenges

Internet and portal use still limited: Despite common perceptions that telehealth is only viable for tech-savvy users, the study found that many people were able to access virtual care even with minimal digital literacy or resources. For instance, 25% of those who said they were uncomfortable using the internet for health care still engaged in a telehealth visit. Similarly, 21% of those without patient portal accounts managed to connect with providers virtually.

One of the most telling data points is that 12% of those who used telehealth said they do not have reliable internet access. This statistic underscores the critical importance of offering telehealth through both video and telephone formats to ensure equitable access to healthcare services, especially through popular telemedicine platforms like Amwell and Teladoc.

Urban and rural disparities: Interestingly, rural participants who did use telehealth were slightly more likely than urban or suburban residents to have done so via video—75% compared to 65% and 69%, respectively. However, urban residents overall were more likely to use telehealth, reflecting higher availability of digital infrastructure in cities.

These urban-rural differences suggest that while video technology can be effective in rural areas, broader implementation may require targeted efforts to improve internet connectivity and digital literacy in underserved regions.

Patient satisfaction and provider communication

Perhaps one of the most striking aspects of the study is the high level of satisfaction reported by telehealth users. A remarkable 92% of those who had virtual appointments felt that their provider adequately addressed their health concerns. This feedback challenges the notion that in-person visits are inherently more effective or personal than digital consultations.

Telehealth also enables providers to maintain continuity of care for chronic conditions, behavioral health, and routine follow-ups, which are often neglected when in-person appointments are difficult to attend. Platforms like Amwell and Teladoc have made it easier for healthcare providers to meet these needs remotely, furthering their role in improving healthcare accessibility for low-income individuals.

Equity and demographic gaps

Despite the positive overall trends, the study highlighted troubling disparities in telehealth use along racial and ethnic lines. White, non-Hispanic Medicaid enrollees were far more likely to have had a telehealth visit in the past year—67%—compared to only 16% of Black enrollees, 6% of Hispanic enrollees, and 4% of those identifying as Arab, Chaldean, or Middle Eastern.

These gaps may be attributed to a range of factors, including mistrust in the health care system, lack of targeted outreach, language barriers, and unequal access to devices or reliable service. Policymakers and health systems need to consider culturally competent strategies to ensure that all communities can benefit equally from virtual care.

Shaping policy and infrastructure

The future of telehealth under Medicaid and Medicare is currently under review by federal lawmakers. With pandemic-era flexibilities set to expire, Congress faces a crucial decision this fall regarding whether to extend or make permanent certain telehealth provisions.

Dr. Terrence Liu, lead author of the U-M study, emphasized that the insights from Michigan could help inform this policy debate. “Telehealth has become much more common in American health care, but data has been scarce on its use by Medicaid enrollees,” he noted. “Our findings provide valuable evidence that can guide future decisions on coverage and access.”

Expanding infrastructure and support

To maximize the benefits of telehealth, investments in infrastructure are essential. Expanding broadband access in rural and low-income communities is a foundational step. Likewise, improving the design and user experience of patient portals, offering multilingual support, and ensuring virtual platforms are accessible to people with disabilities will help make telehealth a long-term solution rather than a temporary fix.

Training providers to deliver effective care in virtual settings and educating patients on how to prepare for telehealth visits can also enhance the quality of the experience for both parties.

The University of Michigan’s telehealth study sheds light on a significant transformation in how care is delivered to Medicaid enrollees. Virtual appointments are not just a convenience—they are a necessary tool for ensuring that low-income individuals, including those in rural or underserved areas, receive timely and effective medical care.

By addressing both digital and systemic barriers, telehealth holds the promise of a more equitable healthcare system. As Congress deliberates the future of telehealth coverage, studies like this one offer clear evidence of its value—and the work still needed to make it universally accessible. Telemedicine platforms like Amwell and Teladoc are key players in this effort, providing essential access to care that might otherwise be out of reach for many.