Why Expiring Waivers Could Worsen the Mental Health Crisis
As we celebrate World Mental Health Day on October 10th, it’s essential to highlight the impact of telehealth on mental health care access, especially as temporary waivers that expanded telehealth services during the COVID-19 pandemic are set to expire. Telehealth played a critical role in increasing access to care, especially for individuals who faced barriers to in-person visits. However, the expiration of these waivers could drastically reduce access to life-saving mental health services, leading to severe consequences for patients across the country.
“However, the expiration of these waivers could drastically reduce access to life-saving mental health services, leading to severe consequences for patients across the country.”
The Role of Telehealth in Mental Health Care
The COVID-19 pandemic saw a dramatic rise in the use of telehealth services as states enacted temporary licensure waivers, allowing patients to seek care from out-of-state providers via telemedicine. This was particularly vital for mental health care, where access is often limited due to geographic, financial, and social barriers.
According to the American Psychiatric Association, the pandemic severely affected the mental health of 78% of adults in the U.S., creating an urgent need for accessible mental health services. Telehealth provided a solution, enabling millions to receive therapy, counseling, and medication management remotely. In fact, a study by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that the use of buprenorphine, a medication for opioid use disorder, surged during the pandemic as telehealth allowed more patients to continue their treatment safely from home (SAMHSA, 2020). In 2024, SAMHSA published a final rule allowing for some opioid treatment program (OTP) providers to prescribe medication for opioid use disorder (MOUD) like buprenorphine via telehealth without an initial in-person exam.
The Expiration of Licensure Waivers
Unfortunately, many of the temporary waivers that allowed out-of-state telehealth relationships have already expired. A recent study by the University of Pennsylvania examined the effects of these waivers and found that, in states where waivers expired, patients were 24% less likely to continue seeing their provider via telehealth, compared to states where waivers remained in effect (Ray et al., 2023). More concerning is the fact that many of these patients didn’t switch to in-person care—instead, they stopped seeking care altogether. This is particularly worrisome for patients in rural or underserved areas who rely on telehealth for consistent mental health support.
“A recent study by the University of Pennsylvania examined the effects of these waivers and found that, in states where waivers expired, patients were 24% less likely to continue seeing their provider via telehealth, compared to states where waivers remained in effect (Ray et al., 2023). ”
The study highlights how the loss of telehealth services will likely exacerbate the current mental health crisis. Patients who can no longer access care remotely may face significant barriers to in-person visits, including long travel distances, time constraints, and additional costs. In rural areas, where mental health services are already scarce, the removal of telehealth options could leave many without any access to care at all. According to the National Rural Health Association, rural Americans face greater mental health challenges, with suicide rates 64% higher in rural areas compared to urban locations (NRHA, 2022). Leaving these individuals without access to life-saving services is negligent, harmful, and unnecessary.
Pending Legislation and the Future of Telehealth
Despite the demonstrated success of telehealth during the pandemic, the future of telehealth access remains uncertain. Several bills, including the Telehealth Modernization Act and the TREATS Act, aim to make the telehealth flexibilities implemented during the pandemic permanent. These bills would allow providers to continue prescribing controlled substances via telemedicine and reduce the need for in-person visits for mental health care. However, without swift congressional action, these protections could lapse, leading to significant disruptions in care.
In 2022, Congress did pass the Consolidated Appropriations Act, which extended telehealth flexibilities for 151 days after the public health emergency declaration ended. While this provided a reprieve, time is running out. CTeL and broader telehealth community are urging Congress to act before the year’s end to ensure that telehealth remains a viable option for millions of Americans.
As we observe World Mental Health Day, it’s important to recognize the role telehealth has played in addressing the mental health crisis. For many, telehealth was more than a temporary solution during the pandemic—it was a vital lifeline to continued care. However, as state licensure waivers expire and legislation stalls, we risk losing this critical resource. If Congress does not act to extend telehealth flexibilities, millions of Americans could find themselves without access to the mental health services they need.
The time for action is now, and the future of telehealth should remain a top priority for policymakers.
References
American Psychiatric Association. (2020). COVID-19 and Mental Health: A Growing Crisis. Retrieved from https://www.psychiatry.org/newsroom/news-releases/covid-19-and-mental-health-a-growing-crisis
National Rural Health Association (NRHA). (2022). Rural Health and Access to Care. Retrieved from https://www.ruralhealthweb.org
Ray, K. N., Polsky, D., Cross, D. A., & Mehrotra, A. (2023). Telemedicine Licensure Waivers and Out-of-State Care During COVID-19. JAMA Network Open. Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805321
Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Opioid Treatment Program Flexibilities During COVID-19. Retrieved from https://www.samhsa.gov