A discussion of technology and the Medicaid population inevitably raises the topic of the digital divide — that is, the gap between people who have access to modern information and communications technology (ICTs) and those who don’t.

“We can’t deliver internet-dependent solutions to Medicaid enrollees because they don’t have access to the internet.” Or so the argument goes. 

But this is an outdated and manifestly untrue statement that relies on a very limited definition of “internet.” Indeed, many low-income and rural demographics do not have home broadband access, but this reality does not extend to mobile broadband.

Ninety-seven percent of adults between the ages of 18 and 49 own a smartphone. These percentages are comparable when broken down by income level — of those who make 30K-69K, ninety percent own smartphones, compared to 94% and 98% in the next highest income brackets. Even among those who make less than 30K annually, seventy-nine percent own smartphones. When considering cell phone ownership, the percentages are near 100%, regardless of income (1).

Low-income groups (primarily served by Medicaid) are in fact more dependent on smartphones than higher-income populations, and their children spend more time looking at screens (a reality that puts a different face on the question of the digital divide — and should raise concerns for those looking into disparities in childhood wellness — but that’s a topic for a different article).

Medicaid populations have and use technology, and misplaced focus on this as a barrier to implementing digital health has the industry ignoring greater challenges like health literacy, trust in the medical system, and reimbursement.

The issue of health literacy

Medicaid beneficiaries are more likely to be at the below basic or basic level of health literacy than those who receive insurance from an employer (60% vs. 37%). Digital health solutions are not typically tailored to those with lower health literacy — the use of medical terminology or jargon can prevent patients from accessing a digital health solution, even when they have the technology to do so. 

But with the availability and increasing sophistication of AI, specifically LLMs (Large Language Models), closing the health literacy gap has never been more attainable. We can lean on these innovations to translate information to a more accessible reading level and support patients in navigating their health information. 

Bolstering trust in the medical system 

A digital health solution can feel like inferior care to a demographic that already feels overlooked and underserved by the system. It cannot be overstated — digital health solutions need to support personal, physical care models, not replace them. There has to be a human element to digital health solutions to build and maintain trust with Medicaid populations. 

Telehealth services that incorporate personal interactions, such as virtual visits with healthcare providers, can offer the human connection that helps bridge this trust gap. Additionally, community health workers and care managers can play a crucial role in guiding patients through digital health tools, ensuring they feel supported and valued. The virtual nature of these solutions broadens the possibilities of physical reach, for example, it’s easier to connect a patient with a care provider that comes from a similar community or shares ethnic or racial background.

Addressing reimbursement issues

Reimbursement remains one of — if not the biggest — barriers to digital care delivery for Medicaid beneficiaries. Because Medicaid is jointly funded by state and federal governments, there’s no standard approach to prioritizing or implementing technology reimbursement. Even in the states where digital tools are covered, complex billing processes and the risk of denied claims can slow adoption. 

But there’s a lot of reasons to be optimistic. Although it’s not universal, Medicaid coverage for remote patient monitoring devices and services is rapidly expanding. In January 2024, the Centers for Medicare and Medicaid Services (CMS) ruled that Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) can now bill for RPM under new global coding. And CMS introduced the Transforming Maternal Health (TMaH) Model, designed to focus exclusively on people enrolled in Medicaid and Children’s Health Insurance Program (CHIP). Plus, many digital health companies provide support models to help health systems navigate the billing process, while offering guarantees to offset or eliminate financial risk. 

Tailoring tech to the Medicaid population

Of course, while technology is a viable solution for Medicaid enrollees, simply repurposing the technology used for upper or middle income patients is not going to produce the same outcome. In order to engage patients and have an impact, digital health for the Medicaid population needs to take into account the particular characteristics and risks of that community — the question is not whether digital health will work for all, but how to make it work for all. 

A good example is the difference between SMS and email for communicating and driving engagement. SMS can reach almost anyone with a basic mobile phone, making it highly accessible — it doesn’t require internet access. Texts tend to be read almost immediately, which is crucial for delivering time-sensitive information like appointment reminders or emergency alerts. Compare that to email, which requires internet access and may not be checked consistently. Email inboxes can get cluttered and emails can go to spam, making it a less accessible and effective form of communication.

Innovators need to be aware that solutions have to be carefully tailored to the specific needs and circumstances of Medicaid populations — but with that considered, the narrative that Medicaid populations cannot benefit from digital health solutions due to a lack of internet access falls apart. With the widespread use of mobile devices and smartphones among low-income individuals, the real barriers lie in health literacy, trust, and reimbursement. By addressing these challenges through targeted strategies, we can ensure that digital health innovations reach and effectively serve Medicaid enrollees, ultimately leading to better health outcomes and a more equitable healthcare system.

About Anish Sebastian

Anish Sebastian co-founded Babyscripts in 2014 with the vision that internet-enabled medical devices and big data would transform the delivery of pregnancy care. Since the company’s inception, they have raised over $40M. As the CEO of BabyScripts, Anish has focused his efforts on product and software development, as well as research validation of their product.