Telehealth services provide a lifeline in Kansas and Missouri. Policy changes put them in upheaval.
Changes in federal policies directly threaten vulnerable clients, practices, and the wider social welfare network, writes Tara Wallace. (Getty Images)
If you practice social work in Kansas or Missouri, you already know that access to care is more than a clinical question. It is a social justice question.
With the recent federal government shutdown and the expiration of pandemic-era telehealth waivers for Medicare, we are now witnessing disruptions that directly threaten vulnerable clients, our practices, and the wider social welfare network.
In October, funding and authorizations for key telehealth flexibilities under Centers for Medicare and Medicaid Services lapsed. These waivers had allowed Medicare beneficiaries to receive telehealth services from home, including audio-only in many cases, removed geographic or originating-site restrictions, allowed a broader list of providers, and sustained the “hospital-at-home” model.
Although CMS says providers may still furnish telehealth services, reimbursement is no longer guaranteed.
For social workers in Kansas and Missouri, our clients face transportation barriers, rural isolation, chronic illness, caregiving demands, mental health needs, and limited mobility. Telehealth has offered a lifeline: home-based services, flexible scheduling, connections across distances. The sudden uncertainty or withdrawal of coverage threatens these gains.
Social workers often deliver or coordinate mental health, substance use, family support, trauma recovery, and other interventions. The tele-behavioral-health flexibilities have been among the more stable, but the broader telehealth framework’s disruption increases the potential for fragmentation of care. And while some behavioral health “home rules” are permanent, many allied services are now destabilized.
The dilemma faced by practitioners in Kansas and Missouri is: Do they continue telehealth with risk of non-reimbursement? Do they revert to in-person only and lose clients who cannot attend? Do they shift staff, workflows, scheduling, risk financial loss, and cut services? This is a major burden on the social work infrastructure.
In the rural counties of Kansas and Missouri, where provider scarcity, long travel distances, and transportation already existed as barriers, telehealth offered a way to increase access. Rolling back those flexibilities threatens to widen disparities and access to critical services.
Social workers have always stood at the intersection of care and policy. This moment is no different. It demands raising our voices with state legislatures, federal representatives, provider coalitions, and communities to ensure that access isn’t rolled back at a time when many of our clients have fewer alternatives.
A stable, predictable telehealth reimbursement environment is critical. Our state practices cannot carry indefinite uncertainty while caring for older adults, rural clients, homebound persons, trauma survivors, and families. Making telehealth flexibilities permanent, or at least multi-year, is not a luxury. It’s a necessity for continuity of care, especially in underserved regions.
Funding and reimbursement must account for the full spectrum of care — not just physician visits but therapy, social work, behavioral health, speech/OT/physical therapy, case management, and community-based wraparound services.
Kansas and Missouri should consider state-level policies and reimbursements to supplement or backstop federal gaps, ensuring no one falls through the cracks when federal policy fluctuates. Social workers in community-based settings, especially those serving marginalized populations, should be included in crafting telehealth policy and program implementation, given our experience with access, equity, digital divides, trauma-responsive care, and culturally sensitive outreach.
To my colleagues in Kansas and Missouri, review your service models. Identify which clients rely on telehealth and map out alternative plans in case reimbursement is delayed or revoked.
Document the impact on clients who lose access or experience delays in services, and increased emergency visits or crises triggered by disruptions. This evidence will be crucial for advocacy. Engage with state chapters of the National Association of Social Work, other social work associations, Medicaid directors, and local behavioral health authorities to raise these issues and propose solutions. Most importantly, communicate with your clients. Be transparent about possible changes. Some may no longer qualify for certain telehealth visits or may have to shift to in-person. Your honesty is especially important during times of upheaval.
For social workers in Kansas and Missouri, this is a moment of real risk and real agency. The lapse of telehealth waivers isn’t just a bureaucratic hiccup. It has the potential to undo gains in access, equity, trauma-responsive care, and community-based support that our profession has worked hard to build. But it is also an opportunity to show how social work bridges practice and policy, care and advocacy, local realities, and federal frameworks.
Our clients deserve no less than consistent, accessible service. Our states deserve a system that leverages telehealth’s promise. And our profession must step forward to ensure no one is left behind.
Tara D. Wallace is a licensed clinician and trauma therapist in Topeka. Through its opinion section, Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.