In the United States, more than 12 million adults aged 40 and older experience vision impairment, a number projected to double by 2050. This surge in vision problems highlights the critical need for routine eye care and corrective measures, such as glasses, which can significantly improve vision and motor function. Medicaid is a crucial program providing health coverage to low-income individuals and families, and its policies can greatly influence access to eye care. Despite the importance of eye care, many adults face barriers to accessing these essential services.
In a study recently published in the journal Health Affairs, corresponding author, Brandy Lipton, PhD, associate professor of health, society, and behavior, at the UC Irvine Joe C. Wen School of Population & Public Health, delves into the state-by-state Medicaid policies during the calendar year 2022, examining how these policies affect adult vision care coverage.
Providing comprehensive vision care could have big benefits in terms of health, quality of life, and even employment and productivity.”
– Brandy Lipton, PhD
While most Medicaid enrollees had coverage for at least some routine vision services, this study reveals important gaps in Medicaid coverage for vision care across the U.S. The study estimates that approximately 6.5 million adult enrollees live in states without comprehensive coverage for routine eye exams. Additionally, around 14.6 million adult enrollees reside in states lacking comprehensive coverage for glasses. These numbers are in line with recent KFF data reporting that 25% of all US adults have unmet needs for routine vision care due to cost and underscore significant access issues. Specifically, 20 states did not cover glasses, and 35 states did not cover low vision aids. This means that even if routine eye exams are covered, many adults cannot afford the glasses or aids they need to correct their vision. About two-thirds of the states with routine eye exam coverage required enrollees to share the costs. Cost-sharing can be a barrier for low-income individuals, potentially deterring them from seeking necessary eye care. Managed care plans generally provided better or at least consistent coverage compared to fee-for-service programs. However, within a state, coverage could vary between different managed care plans, leading to inconsistencies in the availability of vision care services.
“The positive finding from our study is that most fee-for-service Medicaid programs across the states covered routine eye exams which are vital for detecting and addressing vision issues early,” shares Lipton. “However, the substantial gaps highlight opportunities for policy changes to enhance coverage and access.”
Lipton and the team recommend opportunities to increase eye care access through policy changes on both a federal and state level:
- First, policymakers could consider expanding fee-for-service Medicaid programs to cover both routine eye exams and necessary corrective measures like glasses and low vision aids.
- Second, minimizing or eliminating cost-sharing requirements would make vision care more affordable for low-income individuals and may increase use of vision services.
- Third, requirements and/or incentives for managed care plans to provide vision coverage could standardize coverage across plans within states to prevent discrepancies and ensure consistent access to vision care.
- Finally, on a federal level, including routine vision benefits in traditional Medicare would increase access for millions of older adults with significant vision care needs.
“Glasses represent a significant cost to Medicaid enrollees but are relatively low cost for state Medicaid programs to provide. Providing comprehensive vision care could have big benefits in terms of health, quality of life, and even employment and productivity. ” says Lipton.
Research reported in this publication was supported by the National Eye Institute, National Institutes of Health (Award No. R01EY033746). Additional authors include Jenna Garcia from San Diego State University, Michel H. Boudreaux from University of Maryland, Petros Azatyan from UC Irvine, and Melissa Powell McInerney from Tufts University.
