During the COVID-19 public health emergency, the U.S. government enacted a series of telehealth waivers that significantly expanded access to remote healthcare services. These changes were designed to address barriers to care during a time when in-person medical visits carried heightened risks of infection. By relaxing long-standing restrictions and broadening the scope of telehealth, policymakers ensured that millions of patients could continue receiving essential medical care. However, because many of these waivers were temporary, the nation does face a policy crossroad as expiration deadlines approach.
Prior to the pandemic, telehealth under Medicare was restricted by geographic and originating site limitations. Patients typically had to be in a rural area and physically present at a medical facility to access telehealth services. The COVID-19 era waivers removed these restrictions, allowing patients to receive telehealth services from the comfort of their own homes and in any location. This shift significantly expanded access, particularly for vulnerable populations, including the elderly, individuals with mobility challenges, and those living in underserved areas.
The waivers also expanded the scope of providers eligible to deliver telehealth services. Physical therapists, occupational therapists, speech-language pathologists, and audiologists were temporarily authorized to bill for telehealth services. Federally Qualified Health Centers (FWHCs) and Rural Health Clinics (RHC) were permitted to serve as distant site providers, further expanding the pool of available telehealth practitioners. Behavioral health care received significant support as well, with relaxed requirements for in-person visits and broader acceptance of telehealth for mental health treatment.
One of the most transformative flexibilities was the inclusion of audio-only telehealth visits. Recognizing that not all patients had access to reliable broadband or video technology, regulators allowed providers to conduct visits via telephone. This proved particularly valuable for low-income and rural patients, helping to close the care delivery gaps.
Prescribing of controlled substances via telehealth also saw temporary adjustments. The Drug Enforcement Administration (DEA) relaxed requirements for in-person visits before issuing prescriptions, which allowed patients to continue receiving critical medications for conditions such as ADHD, anxiety, and opioid use disorder.
As the public emergency wound down, Congress took steps to extend many of these waivers. The American Relief Act of 2025 extended telehealth flexibilities through March 31, 2025, while the Full-Year Continuing Appropriations and Extensions Act pushed the deadline to September 30, 2025. Yet, unless further action is taken, and right now none has, these waivers are set to expire, which creates what some policy experts call a “telehealth cliff.”
If these waivers expire without replacement, access to telehealth will narrow significantly. Medicare patients may once again be limited to receiving telehealth only in rural areas and from specific originating sites, reducing the ability to access care from home. Audio-only visits would no longer be reimbursed, excluding patients without video technology. Non-physician providers may lose the ability to conduct telehealth visits, shrinking the range of available services. Additionally, the more flexible rules for prescribing controlled substances remotely would tighten, requiring more in-person visits.
Now that the expiration date has passed, critical questions about the future of telehealth remain. Supporters argue that the waivers demonstrated telehealth’s effectiveness and necessity, especially in addressing disparities in access to care. They emphasize that removing these flexibilities would disproportionately harm patients in rural, underserved, and low-income communities. Policymakers have responded by introducing proposals such as the Telehealth Modernization Act, which would extend many of these flexibilities through 2027.
The telehealth waivers enacted during the COVID-19 pandemic represented a historic transformation of the US health care system. They expanded access, reduced barriers, and highlighted the potential of telehealth as a permanent feature of modern care delivery. Yet, now with the expiration day has passed, the nation must decide whether to preserve these gains or return to a more restrictive system. The outcome will shape the accessibility, equity, and effectiveness of healthcare for millions of Americans.