Wisconsin advocates want to keep telehealth, rural hospital funding through Medicare

As Congress works to pass a stopgap funding bill this week, Wisconsin health advocates are keeping an eye on several extensions for Medicare programs providing telehealth services and rural hospital funding.

The program waivers, which are sometimes referred to as health care extenders, were set to expire March 31. The federal funding extension released by House Republicans on Friday would continue these programs through the end of September.

The waivers include flexibilities created during the COVID-19 pandemic for Medicare recipients to use telehealth services from home. Prior to the pandemic, only rural recipients could use telehealth and patients were required to participate in the call from an approved clinic. 

Data shows telehealth has remained popular among the older adults and people with disabilities who receive coverage. Health policy nonprofit KFF found that nearly 13 percent of all Medicare recipients in the U.S. used the services in 2023.

Jim Flaherty, communications director for AARP Wisconsin, said telehealth is especially important in Wisconsin’s rural communities, where populations are getting older and residents have to travel longer distances to access care.

“A lot of times folks don’t have access to any type of care within 30 or 40 miles of where they live in rural areas,” Flaherty said. “They rely on telehealth to be able to have that connection with their doctor. If that goes away, it’s really going to be difficult for them to continue.”

He said the importance to rural health is part of why federal lawmakers have continued the flexibilities through previous appropriations bills. 

AARP and other organizations like the American Hospital Association have advocated for making the telehealth changes permanent. But Flaherty said it’s not surprising that lawmakers have continued the more easily passed waivers instead of taking on the much larger effort to change Medicare.

Rural hospitals depend on higher payments from Medicare waivers

Another COVID-era waiver in the stopgap bill is for Medicare’s Acute Hospital Care at Home program. These hospital-at-home efforts have become increasingly popular among health care systems as a way to treat patients at home instead of admitting them for care.

Jeremy Levin, director of advocacy for the Rural Wisconsin Health Cooperative, said six hospital systems in the state are providing the services. He said the program not only helps with patient comfort, but it can ease the burden on hospitals that are struggling to keep inpatient units fully staffed.

“It can help with keeping sicker patients at a hospital and less sick patients at home,” he said.

While the new treatment modes have helped expand rural services, Levin said the state’s hospital systems are primarily counting on two extensions in the stopgap bill that have been renewed for decades by lawmakers.

The waivers provided increased payment rates for hospitals with lower numbers of patients and those facilities that are considered Medicare-dependent. Levin said the programs are a critical part of how rural hospitals in the state continue operating.

“[They] help fund 16 hospitals within Wisconsin to an annual impact of $228 million,” he said. “That could be a very significant hit if they weren’t extended.”

Levin said these programs were previously renewed for five years at a time. But since the COVID-19 pandemic, the extensions have been pulled into the short-term continuing resolutions.

“That’s a little bit of a disturbing trend and something that we hope can go back,” he said. “Just like every other industry, having some determined and settled law gives that predictability that everyone is hoping for.”