This study examines the association between telehealth expansion, internet speed, and primary care access before and during the COVID-19 pandemic among Wisconsin Medicaid beneficiaries. The research found that telehealth use increased significantly during the public health emergency (PHE), with higher utilization among certain groups, including females, urban residents, and those with chronic conditions. However, disparities in telehealth access persisted, even among individuals with high-speed internet (HSI). The study highlights that while telehealth and HSI may promote primary care access, they are unlikely to close existing utilization gaps. Factors such as race, age, geography, and income influenced telehealth utilization, with non-Hispanic Black and Hispanic individuals showing greater telehealth uptake despite lower pre-PHE utilization. Access to HSI did not moderate these disparities. The findings suggest that telehealth expansion alone may not address health equity, and further research is needed to understand the mechanisms behind these disparities. The study underscores the importance of addressing socioeconomic and geographic disparities in healthcare access to achieve equitable outcomes.This study examines the association between telehealth expansion, internet speed, and primary care access before and during the COVID-19 pandemic among Wisconsin Medicaid beneficiaries. The research found that telehealth use increased significantly during the public health emergency (PHE), with higher utilization among certain groups, including females, urban residents, and those with chronic conditions. However, disparities in telehealth access persisted, even among individuals with high-speed internet (HSI). The study highlights that while telehealth and HSI may promote primary care access, they are unlikely to close existing utilization gaps. Factors such as race, age, geography, and income influenced telehealth utilization, with non-Hispanic Black and Hispanic individuals showing greater telehealth uptake despite lower pre-PHE utilization. Access to HSI did not moderate these disparities. The findings suggest that telehealth expansion alone may not address health equity, and further research is needed to understand the mechanisms behind these disparities. The study underscores the importance of addressing socioeconomic and geographic disparities in healthcare access to achieve equitable outcomes.