Medicaid coverage for adult vision services varies by state, highlights need for expansion
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Key takeaways:
- Fee-for-service Medicaid policies did not cover glasses in 20 states, and 35 states did not cover low-vision aids.
- Seven states had no coverage for exams or glasses under fee-for-service or managed care policies.
According to an NIH-funded study published in Health Affairs, approximately 6.5 million Medicaid enrollees live in states that lack coverage for routine adult eye exams, and 14.6 million live in states without coverage for eyeglasses.
“Our study clearly shows that there are opportunities to expand coverage of routine vision services at the state level, and based on previous research, we expect more generous coverage would reduce rates of vision impairment, improve quality of life and promote health equity,” Brandy J. Lipton, PhD, associate professor of health, society and behavior at the University of California, Irvine, said in a related NIH press release.
Lipton and colleagues examined state-by-state Medicaid policies for 2022 using provider manuals, state Medicaid program websites, legislative documents and beneficiary handbooks to determine variability in adult vision-services coverage.
The researchers found that while most fee-for-service programs cover routine eye exams, 20 states did not cover glasses and 35 states did not cover low-vision aids.
“Visual impairment can be corrected with glasses in most instances, but not all,” Lipton said in the release. “Particularly among older adults, lack of coverage for low-vision aids may be an important gap.”
In addition, results showed eye exams and glasses were covered at least annually in eight states, biannually in 18 states and less frequently than biannually in three states. Eight states provided exam-only coverage and 12 states provided no coverage.
In many cases, states covered additional exams and glasses when medically necessary, with the most restrictive coverage reported in Maine, where glasses were covered only once per lifetime and only if the minimum correction was at least 10.0 D. Only 10 states covered glasses without a specific minimum correction threshold, and 19 states provided replacements for glasses that were lost or broken.
Seven states — Arizona, Idaho, New Mexico, Oklahoma, Tennessee, West Virginia and Wyoming — had no coverage for exams or glasses under both fee-for-service and managed care policies.
“Reducing disparities in vision care is a powerful way to improve quality of life for everyone,” Michael F. Chiang, MD, director of the NIH’s National Eye Institute, said in the release. “This study points to opportunities for expanding coverage to reduce inequities in basic vision care for people with lower incomes.”
Reference:
- Medicaid vision coverage for adults varies widely by state. https://www.nih.gov/news-events/news-releases/medicaid-vision-coverage-adults-varies-widely-state. Published Aug. 6, 2024. Accessed Aug. 22, 2024.
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