NIH study finds disparity in Medicaid coverage for adult vision care
The study found that of Medicaid enrollees, 12% do not have coverage for routine adult eye exams and 27% are without coverage for eyeglasses.
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A National Institutes of Health (NIH) study has found a disparity in Medicaid coverage for adult vision care. Of Medicaid enrollees, 6.5 million or 12% do not have coverage for routine adult eye exams, with 14.6 million or 27% without coverage for eyeglasses.1
The study is based on 2022-23 coverage policies as published in Health Affairs and provides a comprehensive, state-by-state analysis of adult Medicaid benefits for basic vision services in both fee-for-service and managed care, according to a news release.
“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,” said Brandy Lipton, PhD, study author and associate professor of health, society and behavior at the University of California, Irvine, in the release.
Additional findings from the study are that in 20 states, fee-for-service Medicaid policies do not cover glasses at all and in 12 of those states, eye exams are also not covered. For both fee-for-service and managed care policies, the 7 states that had no coverage for exams or glasses under either type of policy include Arizona, Idaho, New Mexico, Oklahoma, Tennessee, West Virginia, and Wyoming. Additionally, low vision aids including magnifiers and loupes were not covered in 35 states.1
“Visual impairment can be corrected with glasses in most instances, but not all. Particularly among older adults, lack of coverage for low vision aids may be an important gap,” said Lipton in the release.
However, coverage was found to not necessarily be the end-all be-all of providing accessibility to eye care services. As many as 66% of states required Medicaid enrollees to cost share in the form of copays. Other restrictive policies were also found to keep enrollees from getting an eye examination or glasses.1 These out-of-pocket expenses for uninsured patients for an eye examination and glasses can cost around $485, which is more than a third of the monthly income of a single adult living at or below the federal poverty line, according to Medical Expenditure Panel Survey data.2
“Reducing disparities in vision care is a powerful way to improve quality of life for everyone. This study points to opportunities for expanding coverage to reduce inequities in basic vision care for people with lower incomes,” said Michael F. Chiang, MD, NEI director, in the release.
References:
Medicaid vision coverage for adults varies widely by state. National Institutes of Health. News release. August 6, 2024. Accessed August 13, 2024. https://www.nih.gov/news-events/news-releases/medicaid-vision-coverage-adults-varies-widely-state#:~:text=A%20study%20supported%20by%20the,states%20without%20coverage%20for%20eyeglasses
Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. Updated January 27, 2023. Accessed August 13, 2024. https://meps.ahrq.gov/mepsweb/data_stats/MEPS_topics.jsp?topicid=45Z-1
