Medicaid coverage for adult vision varies considerably by state (19459000)
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Press release
Tuesday, August 6, 2020
An NIH-funded study found that adults who need eye care are denied it due to lack of insurance, high co-pays, and restrictive policies.
According to a study funded by the National Institutes of Health, 6.5 million Medicaid beneficiaries (12 million, 13 million) live in states that do not cover routine eye exams for adults. And 14.6 million (27 million, 13 million) live in states with no eyeglass coverage. This study, based on 2022-23 coverage policies, was published in Health Affairs. It is one of the first comprehensive, state-by-state analyses of Medicaid adult fee-for-service and managed care benefits.
Medicaid provides health insurance to millions of Americans. This includes low-income adults, as well as children, pregnant women, and seniors. Medicaid is federally regulated, but each state has its own rules, which include determining coverage and eligibility. It is up to the states to decide whether they cover eye exams and eyeglasses. For children, it is essential to remember that federal law provides Medicaid coverage for appropriate and medically necessary services to correct or improve health problems, such as vision services.
Our study shows that it is possible to increase coverage of routine eye care services across states. Based on our previous research, we believe that more generous coverage will reduce the rate of vision impairment and improve quality of life and health equity.
Only an examination by a qualified ophthalmologist can detect eye diseases early and prevent them from leading to vision loss. A prescription for glasses is also necessary to correct refractive errors, which affect more than 12,000,000 people in the United States.
. Coverage for adults at the state level varies considerably, as shown by an analysis of Medicaid enrollment data in 2020 and coverage policies from 2022 to 2023. Gaps included.
- Medicaid fee-for-service policies in 20 states did not include eyeglasses. In 12 states, eye exams were not included.
- In seven states, managed care and fee-for-service policies did not cover eye exams or glasses (Arizona, Idaho, New Mexico, Oklahoma, Tennessee, West Virginia, and Wyoming).
- 35 states do not cover low vision aids like magnifiers or magnifying glasses.
In most cases, vision impairment can be corrected with glasses. Lipton said the lack of coverage for low vision aids could have a significant impact on older adults.
Even in covered states, co-pays or restrictive policies can still prevent enrollees from getting an eye exam or purchasing glasses. Two-thirds (66,133) of all states require enrollees to pay a co-pay.
Data from a Medical Expenditure Panel Survey show that uninsured adults can spend up to $485 on an eye exam and glasses. That's about one-third of the income of a single person living at or below the federal poverty line.
Maine has the strictest eyeglass policy. Only people with very strong prescriptions can get eyeglasses covered once in their lifetime.
According to research, visual impairment increases the risk of falls and hip fractures as well as difficulties in daily activities, depression, cognitive impairment and mortality.
Reducing disparities in vision care provision can improve quality of life for all. The study highlights the need to expand coverage to reduce inequalities in basic vision care among low-income people.
The number of Americans with vision impairment, regardless of cause, is expected to double between 2050 and 2030.
This study was funded by NEI grant R01EY033746.
Reference :
Lipton, BJ, Garcia, J, Boudreaux MH, Axatyan P and McInerney P. Published in Health Affairs, August 5, 2024. DOI:10.1377/hlthaff.2023.00873
NEI is the leading federal research agency in the field of eye diseases and the visual system. NEI funds basic and clinical research programs that develop sight-saving treatments and address the unique needs of people with vision impairments. Visit for more information. https://www.nei.nih.gov.
The National Institutes of Health: NIH is the medical research agency of the United States Department of Health and Human Services. It includes 27 institutes and centers. NIH, the National Medical Research Agency, is the primary federal agency that conducts and supports basic, translational, clinical, and other medical research. It also studies the causes, treatment and cures of common and rare diseases. Visit NIH for more information about its programs and services. www.nih.gov.
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