News Release
Tuesday, August 6, 2024
NIH-funded study finds lack of coverage, copays, policy barriers restricting eye care in older adults.
A study sponsored by the National Institutes of Health (NIH) indicates that 6.5 million Medicaid enrollees (12%) lived in states without coverage for adult eye exams; and 14.6 million (27%) lived in countries without coverage for eyeglasses. The study based on the 2022-23 coverage plans, published in Health News, is one of the first to provide a comprehensive, state-by-state analysis of Medicaid benefits for adults. basic vision services in fee-for-service and managed care.
Medicaid provides health coverage to millions of Americans, including low-income adults, children, pregnant women, the elderly, and people with disabilities. Although the federal government creates the main rules for Medicaid, each state has its own program, including determining eligibility and coverage policies. The law allows states to decide whether there are eye exams and eyeglasses for adults. It is important to note that for children, the federal law provides infants, children and young people enrolled in Medicaid in Medicaid, necessary, necessary and necessary services to repair and improve health conditions, including services of vision.
“Our research clearly shows that there are opportunities to expand regular vision services at the state level, and based on previous research, we expect that providing more subsidies will reduce the rates of vision impairment, improve quality of life, and promote health equity,” said Brandy Lipton, Ph.D., study author and assistant professor of health, society and behavior at the University of California, Irvine .
Examinations by an eye care provider are the only way to detect eye diseases early, when treatment has the best chance of preventing vision loss. Examinations are also important to obtain a prescription for glasses to correct refractive error, the leading cause of vision problems affecting more than 12 million people in the US.
An analysis of 2020 Medicaid enrollee data, and 2022-23 coverage plans, shows that state-level performance for seniors varies widely; Broadcast gaps included:
- In 20 states, Medicaid reimbursement policies did not cover glasses at all; and in 12 of those states, eye exams were also excluded.
- Seven states had no coverage for screenings or copays under secondary fee-for-service and managed care policies (Arizona, Idaho, New Mexico, Oklahoma, Tennessee, West Virginia, and Wyoming).
- Thirty-five states did not provide limited vision aids such as magnifiers and loupes.
“Visual impairment can be corrected with glasses in most cases, but not all. Especially for adults, the lack of protection for low vision aids can be a significant gap,” said Lipton.
In addition, even in states that have coverage for vision care services, copays and restrictive policies may be a barrier for enrollees to follow up with an exam or glasses. . Two-thirds of states required enrollees to share costs.
Data from the Medical Expenditure Panel Survey show that out-of-pocket costs for an uninsured adult for an eye exam and glasses can cost $485, which is more than a third of the monthly income for one adult living below the federal poverty level. .
Maine had a policy that restricted prescription glasses, where glasses were only covered once in a lifetime, and for people who needed an unusually strong prescription to correct their vision.
Previous research shows that vision impairment can increase the risk of falls and hip fractures, problems with daily activities, isolation, depression, cognitive impairment and death.
“Reducing disparities in vision care is a powerful way to improve quality of life for all. This study points to opportunities to expand coverage to reduce disparities in primary vision care for high-income people.” is low,” said Michael F. Chiang, MD, director of NEI.
With the aging of the US population, the number of people with vision impairment from all causes is expected to double by 2050.
This study was funded by NEI grant R01EY033746.
Reference:
Lipton, BJ; Garcia, J; Boudreaux, MH; Akshatyan, P; and McInerney, P. “Most state Medicaid programs cover eye exams for adults, but coverage of some routine vision services varies.” Posted on August 5, 2024 in Health News. DOI:10.1377/hlthaff.2023.00873
NEI leads the federal government’s research on vision systems and eye diseases. NEI supports basic science and clinical programs to develop eye-saving treatments and address the special needs of people with vision loss. For more information, visit https://www.nei.nih.gov.
About the National Institutes of Health (NIH):The NIH, the nation’s national medical research agency, includes 27 Institutes and Centers and is part of the United States Department of Health and Human Services. The NIH is the nation’s premier agency that conducts and supports basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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