Short answer
As of October 2026, launch in every state where your clinicians are licensed and your pharmacy can ship, in one ad set rather than one per state, unless capacity or a state-specific offer says otherwise. Licensing sets the map, because care happens where the patient is. On Meta, switch off the option that reaches people outside your states; on Google, use Presence targeting. MedScale Health, a paid acquisition agency for telehealth brands and clinics, reads results by state before adding more.
What this means for you
- As of October 2026, care happens where the patient is. Target only states where your clinicians are licensed and your pharmacy can deliver.
- On Meta, choose states as regions and switch off Reach more people likely to respond to your ads, which Meta itself suggests for healthcare.
- On Google, change the location option from the default, Presence or Interest, to Presence.
- Neither platform guarantees location accuracy, so the intake should confirm the patient's state first.
- Run one ad set across all your states and read results by state, rather than splitting the budget state by state.
Brands about to launch ask MedScale Health, a paid acquisition agency for telehealth brands and clinics, some version of this: "Do you start marketing all 50 states, or concentrate on just a couple of states or cities?" The answer starts with licensing, then the platform settings, then budget. This page is marketing guidance, not medical, legal or financial advice. Platform policies change, so check the sources listed at the end before acting on a specific rule.
Licensing sets the map
The Federation of State Medical Boards' telemedicine policy, adopted in April 2022, says a physician must be licensed, or appropriately authorized, by the medical board of the state where the patient is located, because the practice of medicine occurs where the patient is at the time of the visit. The exceptions it describes cover established problems, ongoing care and referral screening, which a new patient arriving from an ad usually isn't. Rules for nurse practitioners and physician assistants are set state by state too, so check each board for every clinician type you use.
LegitScript follows the same line. Its standards require merchants to be licensed in the jurisdiction where the patient is located, except where the law permits otherwise, and require certified websites to clearly disclose every state where services are available. Its FAQ asks certified businesses to report expansion into new jurisdictions.
The Interstate Medical Licensure Compact offers physicians a voluntary, expedited pathway to licenses in several states. Its commission lists 44 member states and two territories as of September 30, 2026, with some still putting the compact into practice. It speeds licensing up. Each state still issues its own license.
How Meta targets states
Meta's location targeting reaches people who live in, have recently spent time in or go often to the countries, regions, cities and postal codes you choose, and US states are regions. When you pick a city or region, Meta may turn on Reach more people likely to respond to your ads by default. That adds people interested in the place, including people living in nearby towns or with friends there. Meta lists a sensitive industry such as healthcare, with strict location targeting limitations, as a reason to turn it off. Turn it off.
Meta also says complete accuracy cannot be guaranteed and you might receive leads from outside your location settings. Exclusions depend on both current and home location, so someone who lives in an included state may see your ad while visiting an excluded one.
How Google targets states
Google's default location option, Presence or Interest, reaches people in or regularly in your locations and people who have shown interest in them, for example through searches that name the place. Google says to consider Presence when your business falls within a sensitive vertical with strict targeting limitations, or when you only want people in specific locations. For telehealth licensed in some states, Presence is the setting. Google adds that it may show ads in closely related nearby areas and that 100% accuracy is not guaranteed.
The intake is the last check
Because no platform guarantees location, the first intake question should be the patient's state, with a clear message and no charge for anyone outside your licensed states. That protects the patient, the clinicians and the certification, and stops out-of-state clicks from turning into refunds.
One state, a few, or all of them
Unless something operational says otherwise, launch in every state you can legally serve, in one ad set on Meta and one campaign on Google. Meta says ad sets usually leave the learning phase after about 50 results a week, and its guidance on combining ad sets says splitting an audience across several ad sets can decrease performance and keep each one in learning longer. One ad set per state divides the same budget into pieces that each learn more slowly. Meta's reporting breakdowns show results by region, so you can still read every state.
There are good reasons to start smaller: clinicians who can't absorb demand from every state, a pharmacy that ships to only some, a price that differs by state, or a state rule that changes the visit. Then launch where the operation is ready and add states as it catches up. A one-state soft launch is a test of operations. It tells you less about the ads, because one state is a smaller audience to learn from.
Budget per state
Don't split the budget evenly by state. States differ in population and demand, and the delivery system spends where it finds results. Set one budget, then use the region breakdown to check cost per patient by state against what a patient is worth to you. Give a state its own ad set only when it needs a different offer, page or budget cap, for example because clinician capacity there is limited.
Signs it's time to add states
- Cost per patient holds under your ceiling, but budget increases stop buying more patients. Meta says that when lower cost opportunities run out, the system may move on to more expensive ones.
- New creative no longer brings cost per result back down in your current states.
- Clinician licenses in new states are in hand and the pharmacy can ship there.
Adding a state, in order
- Clinicians licensed in the new state, and the pharmacy able to ship there.
- Website updated to list the new state, and LegitScript told about the expansion.
- Intake updated to accept patients from the new state.
- State added to the Meta ad set and the Google campaign with the same settings as the rest. Meta counts any change to targeting as a significant edit that restarts learning, so add new states in one batch rather than one at a time.
What MedScale does
MedScale Health builds the targeting from the brand's licensed states, switches off the platform options that reach beyond them, reads cost per patient by state every week and adds states in batches once licensing, pharmacy and intake are ready. The intake check stays in place, because no platform guarantees location. Book the free growth audit for a written launch plan by state.
Common questions
- 01Can telehealth ads target specific states on Meta?
- Yes. Meta lets you choose US states as regions in location targeting. Switch off Reach more people likely to respond to your ads, which can add people outside your states; Meta itself suggests turning it off for healthcare.
- 02Which Google location setting should a telehealth brand use?
- Presence, which reaches people in or regularly in your targeted locations. The default, Presence or Interest, also reaches people who have shown interest in a place, and Google suggests Presence for sensitive verticals with strict targeting limits.
- 03Should we start in one state and go national later?
- Start where clinicians are licensed and the pharmacy can ship. If that is many states, launch across all of them in one ad set and read results by state. Start smaller only when capacity, a state-specific offer or a state rule requires it.
- 04What do we tell LegitScript when we add a state?
- LegitScript asks certified businesses to report expansion into new jurisdictions, and its standards require the website to list every state where services are available. Update both before ads reach patients in the new state.
Sources
- 01FSMB: The Appropriate Use of Telemedicine Technologies in the Practice of Medicine (adopted April 2022)checked October 12, 2026
- 02LegitScript: Healthcare Certification (standards and fees)checked October 12, 2026
- 03LegitScript: Healthcare Certification FAQschecked October 12, 2026
- 04Interstate Medical Licensure Compact Commission (snapshot as of Sep 30, 2026)checked October 12, 2026
- 05Meta Business Help Center: About location targeting in Meta Ads Managerchecked October 12, 2026
- 06Meta Business Help Center: How to reach people interested in your selected cities and regionschecked October 12, 2026
- 07Google Ads Help: About advanced location optionschecked October 12, 2026
- 08Google Ads Help: About targeting geographic locationschecked October 12, 2026
- 09Meta Business Help Center: About the learning phasechecked October 12, 2026
- 10Meta Business Help Center: Combine ad sets and campaigns to reduce audience fragmentationchecked October 12, 2026
- 11Meta Business Help Center: Significant edits and learning phasechecked October 12, 2026
- 12Meta Business Help Center: Understand fluctuations in ad performancechecked October 12, 2026
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Last reviewed October 12, 2026. Platform policies change often; we re-verify every answer quarterly.