Telemedicine Expansion Failed to Improve Rural Mental Health Access, Brown University Study Reveals

The promise of telemedicine to bridge the mental health care gap in rural America has not materialized, according to a new study from Brown University School of Public Health published in JAMA Network Open on March 5, 2026. Despite dramatic increases in virtual visits during and after the COVID-19 pandemic, mental health specialists using telemedicine heavily saw only marginally more patients from underserved areas—and actually treated fewer new patients overall.

Researchers analyzed Medicare billing records from 2018 to 2023 for 17,742 mental health specialists across the country, grouping providers based on their telemedicine usage. The findings challenge widespread assumptions about technology's role in expanding access to care.

Minimal Gains in Rural Reach

Compared with specialists who used telemedicine less frequently, those who relied on it heavily saw only 0.9 percentage points more rural patients and 0.1 percentage points more patients from areas lacking reliable access to mental health providers. Even the most generous measure—patients located 20 miles or more from their provider—showed an increase of just 2.6 percentage points.

"We had thought the dramatic shift from in-person care to telemedicine among mental health specialists would lead to them caring for substantially more patients in rural communities," said Drew Wilcock, a lead research scientist at Brown's School of Public Health. "Unfortunately, we just don't see it."

The modest increases that did occur primarily reflected existing patients who had moved away from their providers and continued care virtually, rather than new patients from rural areas accessing care for the first time.

The Unintended Consequence: Fewer New Patients

Perhaps more troubling, the study revealed that specialists using telemedicine more frequently saw 3.6 percentage points fewer new patients overall. This suggests that while virtual care helps maintain long-term relationships with existing patients, it may reduce providers' capacity to accept new patients—the opposite of what policymakers expected when they expanded telemedicine flexibilities.

The finding has significant implications for mental health systems already struggling with waitlists and limited provider availability. If telemedicine is occupying appointment slots without expanding the total patient pool or reaching underserved populations, it may be perpetuating rather than solving access inequities.

Structural Barriers Remain

The researchers pointed to state licensing requirements as a critical barrier preventing telemedicine from fulfilling its potential. Currently, mental health providers must obtain separate licenses in each state where they treat patients, creating administrative burdens that discourage cross-state practice.

"Currently, it is too administratively burdensome for a mental health physician to get a license in many states," said lead study author Jacob Jorem from Harvard Medical School. "By changing how states license clinicians and making it easier for them to practice across state lines, this could help specialists reach more patients in rural communities."

Other structural barriers include unreliable broadband internet in rural areas, lower rates of smartphone and computer ownership among low-income populations, and limited digital literacy among older adults—all factors that prevent vulnerable populations from benefiting from virtual care.

Policy Recommendations

The study authors called for targeted interventions rather than simply expanding telemedicine availability.

"The potential of telemedicine can't be ignored," said study author Ateev Mehrotra, a professor of health services, policy and practice at Brown. "But simply offering telemedicine will not address the barriers that many rural patients face in obtaining mental health care. For telemedicine's potential to be reached, we need policy interventions to address those barriers. Improving how we license physicians is a critical first step."

Potential solutions include:

Interstate Licensure Compacts: Several states have joined the Interstate Medical Licensure Compact, which streamlines the process for physicians to obtain licenses in multiple states. Mental health professionals could benefit from similar arrangements specifically tailored to telehealth practice.

Broadband Infrastructure Investment: Federal programs like the Rural Digital Opportunity Fund aim to expand high-speed internet access, but deployment has been slower than anticipated. Mental health advocates argue that telehealth reliability should be a priority metric for these investments.

Medicaid Reimbursement Parity: Some states still reimburse telehealth visits at lower rates than in-person care, creating financial disincentives for providers to offer virtual appointments. Ensuring payment parity could encourage broader adoption while also supporting providers in underserved areas.

Implications for Addiction Treatment

The findings have particular relevance for substance use disorder treatment, where telehealth has been promoted as a critical tool for expanding access to medications like buprenorphine. The federal government eliminated the in-person evaluation requirement for buprenorphine prescribing via telehealth in 2023, a policy change intended to reduce barriers for people seeking medication-assisted treatment.

But if the pattern observed in mental health care holds for addiction treatment, telemedicine alone may not be reaching the rural populations with the highest overdose rates. Rural areas continue to face higher rates of opioid-related deaths than urban centers, particularly in Appalachia, the Midwest, and parts of the Southwest.

The study suggests that expanding telehealth access without addressing licensing, infrastructure, and reimbursement barriers may simply redistribute existing care rather than create new pathways to treatment.

The Convenience Paradox

Telemedicine does provide undeniable convenience for patients who already have established relationships with providers. People who relocate for work, college students returning home for breaks, and individuals with mobility limitations all benefit from the ability to continue therapy virtually.

But convenience for some does not equal access for all. The Medicare data analyzed in the study showed that telemedicine's primary beneficiaries were existing patients maintaining continuity of care, not new patients in underserved areas initiating treatment.

This "convenience paradox" reflects broader inequities in health care: Technologies marketed as democratizing access often reinforce existing advantages for those already connected to the system.

What Comes Next

The study was funded by the National Institute of Mental Health and represents one of the largest analyses of telemedicine use patterns among mental health specialists. The data span a critical period from 2018—before the pandemic—through 2023, when virtual care had become standard practice.

As Congress debates the future of telehealth flexibilities first authorized during the COVID-19 emergency, this research offers an evidence-based counterweight to optimistic assumptions. Without policy changes that specifically target rural access and remove structural barriers, expanding telemedicine may have limited impact on the populations that need it most.

For mental health and addiction treatment providers, the findings underscore the need for hybrid models that combine virtual care with mobile clinics, peer support networks, and community-based services. Technology is a tool, not a solution—and its effectiveness depends on the infrastructure and policies surrounding it.

The research team hopes these findings will prompt action from state legislatures and federal agencies to transform telemedicine from a convenience for existing patients into a genuine pathway to care for underserved communities.