<p>Telehealth is increasingly a standard and routine clinical option, indicating a changing outlook for SUD treatment from in-person to the more convenient option of telehealth. As populations across geographies increasingly prefer telehealth, more research is warranted that focuses on how where a person lives is associated with telehealth availability. The authors used the Mental Health and Addiction Treatment Tracking Repository (MATTR 2024) to identify telehealth availability among all known licensed SUD treatment facilities in the USA (<i>N</i> = 10,492 facilities). The authors merged external geocoded data to MATTR to characterize the communities and spaces immediately surrounding each facility, including social vulnerability indices (census tract), population demographics (county), and state-level telehealth policies. Multilevel multivariable logistic regression was used to model telehealth availability. Roughly 4 out of 5 treatment facilities (81%) offered telehealth. At the census tract level, for every additional point on the racial/ethnic minority status vulnerability scale, the odds of a facility offering telehealth decreased by 4% (aOR = 0.96, 95% CI = 0.93–0.99, <i>p</i> = 0.02). Compared to states with substantial legal barriers about starting telehealth by any mode, facilities in states with stronger, innovation-ready laws had higher odds of offering telehealth (aOR = 1.47, 95% CI = 1.13–1.92, <i>p</i> &lt; 0.01). Similarly, facilities in states that minimize barriers to allowing nurses to practice and use telehealth independently had higher odds of offering telehealth (aOR = 1.42, 95% CI = 1.09–1.84, <i>p</i> &lt; 0.01). State-level health policies impact access to SUD care in a multitude of ways, and new policies that promote telehealth by minimizing barriers to service delivery will benefit people in need of SUD treatment.</p>