Telehealth across state lines after the latest enforcement actions
The pandemic-era licensure flexibilities are gone, and state medical boards in 2026 are pursuing telehealth providers with renewed focus.
The temporary licensure flexibilities that let providers practice telehealth across state lines during the pandemic largely expired by the end of 2023. The next two years were quieter than expected because state medical boards did not have the resources or political appetite to immediately enforce, and many telehealth platforms continued to operate as if the flexibilities had quietly become permanent. That space has closed in 2026, and several recent state board actions make the new posture visible.
The structure of the rule has not changed in years. To practice medicine in a state, you generally need to be licensed in that state. The relevant question for telehealth is where the patient is located at the time of the encounter, not where the provider is located. There are exceptions: the Interstate Medical Licensure Compact (a fast-track multi-state path for physicians), various state-specific telehealth registration regimes, and limited carve-outs for consultation rather than diagnosis or prescribing. None of those exceptions cover the typical direct-to-consumer telehealth model.
For wellness platforms that connect consumers with clinicians, three things have shifted in practice.
First, state boards are increasingly treating the platform itself as engaged in the unauthorized practice of medicine when the platform’s matching, intake, and clinical-decision-support features look substantively like clinical judgment. The platforms that have stayed clear of this have done so by drawing a clean operational line between the platform’s product and the clinician’s decision-making, with documentation showing the clinician’s independence at every touchpoint.
Second, the prescribing patterns that were viable during the pandemic, particularly for controlled substances, have narrowed significantly. The DEA’s telemedicine rule revisions and parallel state laws have reinstated in-person evaluation requirements for many controlled substance prescriptions. Wellness platforms whose business depends on prescribing flow have had to redesign their clinical pathways or accept that some categories of prescribing are off the table.
Third, marketing claims about provider availability and “any time, anywhere” access are being read by state boards as implicit licensure claims. If a platform advertises that it can connect a consumer in a state to a provider, the platform is implicitly representing that the connection is lawful. State boards have asked platforms to substantiate that representation for every state listed in marketing materials.
The practical takeaway for wellness operators is to map your provider network against the patient locations you actually serve, and confirm that for every state where you have served a patient in the last 12 months, you have a lawful licensure or compact pathway, an accurate platform description that does not implicitly practice medicine, and prescribing pathways that comply with both DEA and state controlled substance rules. Most platforms that have done this exercise have found a state or two where they were operating outside the lines without realizing it. Better to find that during a Monday strategy review than during a board complaint.