State telehealth policy impacts the spread of e-consult for the safety net, as states have wide latitude to regulate Medicaid. Ensuring adoption and sustainability of e-consult programs for underserved patient populations to improve access to cost-effective, quality specialty care requires clear and robust state-level Medicaid policy. The E-Consult Workgroup includes payers, providers and patient advocates from across the country that collaborate on policy changes to reach this goal.