Telehealth refers to virtual appointments between a patient and a medical professional such as a doctor or counselor. These consultations may take place through video platforms, phone calls or other digital mediums. Generally, all medical professionals must be licensed by the state in which their patients are currently residing in or traveling through. Throughout the United States, rules dissuading interstate consultations have persisted, mostly due to the potential legal difficulties of disentangling medical issues across state lines. States aim to have control regarding the amount of expertise and education held by those treating their residents. However, in the past few years, the media has brought awareness to several cases in which out-of-state treatment would have been preferable and beneficial for patients. For example, a person with a specific type of cancer could benefit from a virtual consultation with an out-of-state specialist. Therapists must also be licensed by the state their patient currently resides in, meaning students who have traveled for college or people on vacation cannot connect with their at-home therapist who they may have built a relationship with.
As the COVID-19 pandemic escalated in the United States during 2020, most appointments were conducted virtually to reduce the spread of the virus. Governor Whitmer’s executive order from March 21, 2020 effectively suspended the requirements of the Public Health Code’s Article 15 in order to allow a medical professional licensed in another state to practice in Michigan. Whitmer’s state of emergency also relaxed the requirements for license renewal for those who were qualified to transport or assist sick patients. Actions to temporarily loosen licensing rules were reflected throughout the fifty states and allowed patients to have more flexibility regarding who was treating them.
When COVID-19 restrictions began to loosen near the end of 2020 and into the following year, doctoral and mental health practices began to face legal complications again, unable to connect virtually with their patients across state lines. This compelled people, such as those from rural areas or those in Washington D.C., to drive across state borders to complete their telehealth call from a car parked in the practitioner’s state. The reinstatement of these rules affected patients who had previously connected with out-of-state practitioners due to COVID-19 or other ailments. These rules also impacted Michigan students in virtual school during 2020 to 2021. For example, a student with a Michigan-licensed speech therapist could not legally see them if the student was joining their appointment from another state.
Even before the pandemic, Michigan politicians drafted legislation to combat the issues regarding the licensing process for health officials who wanted to virtually connect with Michigan patients. House Bill 4042 from 2019 proposed the idea of creating a singular process that yielded a nursing license valid in all participating states. In a similar way, the Senate Bill 0758 of January 2020 proposed that Michigan join a group of states that would collectively license psychologists and allow them to practice teletherapy throughout those participating states.
Governor Whitmer vetoed each of these proposals on December 30, 2020. In her official writing to Michigan’s Senate and House of Representatives, she quoted Section 4, Article 51 of the 1963 Constitution: “…public health and general welfare of the people of the state are hereby declared to be matters of primary public concern. The legislature shall pass suitable law for the protection and promotion of the public health.” With this reference, Whitmer argued that each state has the responsibility to determine the necessary qualifications required for their healthcare workers. Others across the United States make similar arguments to Whitmer’s, and they are a primary reason why strict interstate telehealth laws still remain in 2023. By requiring out-of-state professionals to acquire a license before consulting their patients, states can determine their own standards for the education and professional experience of every practitioner. This also prevents potential legal issues that would be difficult to resolve across state lines. Although having state-dependent licensing processes avoids legal problems, some situations such as teletherapy continue to present a need for interstate practicing. Therapists, doctors and nurses can apply to earn a license from a state they do not reside in; however, this process can be costly and timely when educational requirements differ in each state.
The current state of telehealth legislation in Michigan and throughout the majority of the United States continues to affect the nation, including the Hope College community. Students from other states who partake in counseling at home are unable to continue connecting with their personal therapists while at Hope due to the current legislation. While this could affect many out-of-state students, freshmen who are leaving their immediate support systems are especially impacted. Additionally, the inability to contact a familiar counselor would likely add stress to a student’s already challenging transition. Here at Hope, Counseling and Psychological Services (CAPS) and the Campus Ministries staff are local support systems for those adjusting to college or those going through difficult times. Since seeking support and fostering connection remains an imperative part of life, possible interstate health service legislation in Michigan and throughout the United States, would be a gamechanger.