California politicians shouldn’t forget the effectiveness of telehealth
Photo 189236766 © Denis Kalinichenko |


California politicians shouldn’t forget the effectiveness of telehealth

California's antiquated licensing laws and regulations prevent patients from accessing needed health care.

Many Californians used telehealth services for the first time during the COVID-19 pandemic. The rapid rise in telehealth during the pandemic was made possible, in part, by emergency actions that loosened regulations related to telehealth care. Unfortunately, California’s emergency actions have since expired. The state’s antiquated licensing laws and regulations prevent patients from accessing needed health care.

A recent Reason Foundation report finds that California lags behind many other states in adopting best practices for telehealth. In particular, California’s outdated regulations raise obstacles for patients seeking care from nurses and doctors licensed in other states.

Nearly nine million Californians live in areas with shortages of primary care health professionals, meaning there aren’t enough primary care practitioners in their region to meet the demand for care. The U.S. Department of Health and Human Services estimates that an additional 1,460 primary care practitioners are needed to alleviate these shortages.

Similarly, as California’s population ages over the next decade, workforce shortages in the health care industry are expected to worsen. Projections from the Healthforce Center at the University of California—San Francisco suggest that the state will require an additional 4,100 primary care clinicians by 2030 to meet demand. When surgeons and other specialty physicians are included, projections indicate that California will need an additional 32,000 physicians by 2030–the largest need among the 50 states.

Telehealth technologies can help address these shortages by enabling patients to connect with doctors remotely, regardless of their physical locations. However, California requires out-of-state health care professionals to obtain an additional California-issued license to provide telehealth services directly to people in California. Unless they go through the costly and burdensome process of obtaining a California license, out-of-state practitioners can only give a telehealth consultation if a California-licensed physician is ultimately responsible for the patient’s care. As a result, many Californians must travel to other states for the health care they need.

In 2023, Gov. Gavin Newsom signed Assembly Bill 1369, allowing cross-state telehealth services under very limited circumstances. Under the law, physicians licensed in other states may deliver telehealth care to California patients with an “immediately life-threatening disease or condition.” In other words, this flexibility is only available when there is “a reasonable likelihood that death will occur within a matter of months” and the patient “has not been accepted to participate in the nearest clinical trial to his or her home.”

While the law is a positive step in the right direction, several states have gone much further in embracing cross-state telehealth for all types of patients. Florida, for example, adopted a streamlined telehealth registration process that allows out-of-state doctors and nurses to provide telehealth services in Florida without obtaining a Florida license.

According to a recent Cicero Institute report, more than 14,000 out-of-state practitioners registered to provide telehealth services in Florida within the first two and half years of the program, and none of these practitioners received complaints that resulted in disciplinary actions. Arizona, Delaware, Indiana, Louisiana, Utah and Vermont have adopted similar telehealth registration programs.

California is home to Silicon Valley––the global epicenter of technological innovation––but the state’s laws haven’t kept pace with changes in health care technology. With the state facing a significant and growing shortage of doctors and nurses, lawmakers should look for ways to leverage technological innovations to help meet this challenge. The most immediate improvement state leaders could make is simplifying the process for licensed out-of-state health care providers to see patients in California. By removing regulatory obstacles, more Californians can access the vital health care services they need.

A version of this commentary first ran in The Orange County Register.