Barriers

Texas requires an established provider-patient relationship or an initial video visit before telehealth services, a barrier to first-contact remote care for new patients.

Massachusetts has not joined the Interstate Medical Licensure Compact, so clinicians licensed in other states must obtain full Massachusetts licensure to see Massachusetts patients by telehealth — a barrier to cross-state care.

California has not joined the Interstate Medical Licensure Compact, so out-of-state physicians must obtain full California licensure to treat California patients by telehealth — a barrier to cross-state continuity of care.

New Jersey requires insurers to reimburse telehealth at in-person rates — but only through July 1, 2026. The scheduled sunset means telehealth access could narrow when parity lapses, an identified risk to durable coverage.

New York is one of the states outside the Interstate Medical Licensure Compact, so out-of-state physicians must obtain a full New York license to treat New York patients via telehealth — a significant barrier to cross-state care.

Texas requires private payers to cover telehealth but not to pay the same rate as in-person care. The reimbursement gap discourages providers from offering telehealth, narrowing access.

Florida requires telehealth providers licensed elsewhere to register with the state before treating Florida patients, adding a regulatory step that delays or blocks cross-state telehealth care.

Patients who travel to Monterrey's JCI-accredited specialty hospitals lack a coordinated link back to Texas providers. No shared record or referral channel exists, so specialty findings don't reach the home care team.

Americans treated at JCI-accredited hospitals in Tijuana have no coordinated handoff back to their California primary-care provider. Follow-up records and instructions rarely transfer, so post-procedure care is fragmented.

Patients crossing from Tamaulipas to Texas for care arrive without transferable clinical records. Mexico's records standard and Texas systems aren't interoperable, forcing duplicate workups and risking gaps in care.

A physician licensed in Sonora has no pathway to provide telehealth to a patient who has crossed into Arizona. The U.S. interstate licensure compact is U.S.-only, so Mexican licensure doesn't bridge the border.

People who receive mental-health care on one side of the San Diego–Tijuana border cannot easily continue treatment on the other. State frameworks and provider licensing don't coordinate, so care effectively restarts on each crossing.

Wyoming requires out-of-state physicians treating Wyoming patients via telehealth to have established care in person, and after six months of telehealth an in-person encounter is required before telehealth may resume.

Wyoming has no private-payer telehealth law, so insurers are not required to reimburse telehealth at the same rate as in-person care. Commercial telehealth coverage and payment are left to plan discretion.

Wyoming Medicaid excludes audio-only telephone conversations from its telehealth definition. Telephone-only visits are therefore not reimbursable as telehealth.

Wisconsin has no private-payer telehealth law, so commercial insurers face no telehealth coverage or payment-parity mandate. Plans are not required to cover telehealth or reimburse it at the in-person rate.

West Virginia requires out-of-state providers to register as interstate telehealth practitioners with the appropriate WV licensing board before serving WV patients. They must be licensed and in good standing in their home state.

West Virginia Medicaid does not reimburse audio-only telephone consultations. Coverage requires real-time interactive communication with both audio and video equipment.

Washington covers audio-only telehealth only for established patients. The patient must have had an in-person or audio-video visit with the provider or medical group within the past three years before audio-only can be billed.

Virginia requires insurers to cover telehealth on par with in-person for eligibility, but has no explicit payment parity. Plans are not required to reimburse telehealth at the same rate as in-person and can deny technical fees.