Making Eye Health a Population Health Imperative Vision for Tomorrow (2016) / Chapter Skim
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Appendix G: Medicaid Vision Coverage by State
Appendix G: Medicaid Vision Coverage by State
Pages 523-566
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G Medicaid Vision Coverage by State 523
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b Alabamac Children under age 19 and Medicaid pays for eye Medicaid pays for eye exams and $1.30–$3.90 pregnant woman up to examinations and glasses eyeglasses once every 3 calendar years. per optometric 146% of federal poverty once every calendar Contact lenses may be provided only visit (Alabama level (FPL)
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. Arizonae Children under age 1 with Vision exams and glasses "Treatment of medical conditions of family income capped at are covered for children the eye, excluding eye examinations for 147% of FPL.
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Contact lenses, Medicaid beneficiaries every 12 months; eyeglasses for women with incomes up to if medically necessary, are lens replacement as medically necessary patients ages 21 209% of FPL; parents covered but require with prior authorization (and must fit and older
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. Californiaf "Children from birth Children "are eligible for a "All Medi-Cal members are eligible for a Some members through age 18 with family routine eye exam every 24 routine eye exam every 24 months, which have a $1 income levels up to 266% months, which checks the checks the health of the eyes and tests copay, others of FPL; pregnant women health of the eyes and tests for an eyeglass prescription . . .
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. family income up to 195% pleoptic vision training for of FPL; pregnant women children with a diagnosis of with family income up to convergence insufficiency 260% of FPL qualify for (Colorado Medical CHP+; non-elderly adults Assistance Program, 2015)
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For members who are for HUSKY B to 258% FPL; parents of opticians. . . . Eye exams age 21 or older, one (1)
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A for 1 pair of glasses every 2 years. A service for glasses FPL; pregnant women with minimum diopter correction minimum diopter correction is required (Kaiser Family incomes up to 319% of is required.
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Members can receive Kaiser Family family income up to 133% with minimum diopter medical diagnostic and treatment services Foundation, of FPL; pregnant women change. Polycarbonate for ocular disease.
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; spare glasses" (Hawaii Department of Health, 2011b, p. 3) Idaho "Children ages 0–5 with One eye examination during Services necessary to treat or monitor a "$3.65/visit, up family income up to 142% any 12-month period by a chronic condition, such as diabetes, that to 5% of income/ of FPL.
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. Illinois "Children ages 0–18 with "One routine eye exam "Diagnosis and treatment of medical $3.65/visit to family income levels up to each year.
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. Iowan "Children up to age 1 with Eye exams covered once Eye exams covered once every 12 months $2/day for family income up to 375% every 12 months and more and more often if there are complaints or optometrist or of FPL.
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Children ages (Kaiser Family 6–18 with family income up "One complete eye exam covered every Foundation, to 133% of FPL; children 4 years . . . however a total of two eye 2012a,b)
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. Kentuckyo "Children up to age 1 with New patient eye exams New patient eye exams limited to one $3/visit for family income up to 195% limited to one every 3 years, every 3 years, established patient eye adults, $0/visits of FPL.
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. Maine "Children up to 1 year old One annual routine eye One routine eye exam covered every 3 $0.50–$2/ with household income up exam covered (Maine rolling calendar years, unless specific day of service to 191% of FPL.
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. or UV lenses covered when medically copay between with household income up Eyeglasses covered when the necessary.
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Children if determined to be for corrective lenses. Vision therapy is glasses; $2/visit ages 1–18 with household medically necessary by covered for limited clinical conditions (Kaiser Family income up to 160% of FPL; a licensed optometrist (MDHHS, 2016, p. 25)
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Eye exams are covered without copay; $3/optician with household income up for children" (Minnesota eyeglasses are covered without cost visit, or $25/ to 283% of FPL. Children DHS, 2016)
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. Missouri "Parents with dependent One eye exam covered One eye exam allowed per 2 years, $0.50–$3/service children are eligible with per year (MO HealthNet, allowed every year for the blind, pregnant for glasses or visit household incomes up to 2016)
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"Eye examinations to determine the $2/pair of children are eligible with More frequent eye exams need for glasses, the purchase of glasses, glasses or visit income up to 58% of covered if medically and necessary repairs. . . . Eye exams (Kaiser Family poverty.
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Vision therapy covered with can be up to 160% of FPL, ophthalmologists may prior authorization (DHCFP, 2015)
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Eye exams covered "to diagnose and monitor medical conditions of the eye" (New Hampshire Medicaid, 2013, p. 4)
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One frame and set ranges from $0 to income up to 138% of otherwise medically of corrective lenses covered every $7 (Kaiser Family poverty. Pregnant women necessary. One frame 36 months; "more frequently when Foundation, are eligible for pregnancy- and one set of corrective an ophthalmologist or optometrist 2012b)
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Orthoptic training may be covered with prior authorization (New York State Medicaid Program, 2013)
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contact lenses covered for the correction Photochromic, tinted, UV, of certain conditions. Replacement lenses slab-off, and Fresnel prism and frames covered after 24 months lenses covered if medically (NDDHS, 2010)
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. Ohio "Adults are eligible with "One exam and pair of Adults ages 60 and older are eligible for $2/refractive incomes up to 133% of eyeglasses covered every 12 "one eye exam and one pair or eyeglasses exam and $1/ FPL. Children are eligible months (individuals younger every 12 months" (ODM, n.d.)
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. benefits."z Oregonaa "The aged, blind, and Eye exams and glasses Eye exams covered for pregnant women.
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Also children exam and one complete 21 and over are non-covered services. optometrist visit with household incomes up set of glasses covered once Routine vision services are defined as for adults over to 208% of FPL; working a year (South Carolina services related to refractive care: routine age 21 (South parents with dependent Health Connections, eye exams, refractions, corrective lenses, Carolina Healthy children with household 2016)
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. Texasff "The aged, blind, and Children's Medicaid covers "One examination of the eyes by disabled. Also, parents eye exams and eyeglasses refraction may be provided to each eligible with dependent children (Texas HHSC, 2014)
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No copay for for pregnant women with including lenses and Additional eye exams can be done when the annual eye incomes up to 139% of frames" are covered by medically necessary (Utah Department exam if done poverty, children with Utah Medicaid under of Health, 2015)
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Routine 21 (DVHA, household incomes up to within the 24 month eye exams with the following limitations: 2016b)
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. Washingtonjj The aged, blind, and Vision hardware is covered Eye exams covered for asymptomatic disabled. Also, adults for beneficiaries under clients once every 24 months (Washington with incomes up to 133% age 20, including, vision Apple Health, 2016a)
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. Cataract surgery (Kaiser Family incomes up to 100% of covered when medically necessary.
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. household incomes up to clients under the age of 154% of poverty (children 21, with limits, covered Eye exams are only covered for the are eligible for CHIP with when provided by an treatment of eye disease or eye injury.
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ii Personal communication, B McCormick, Virginia Department of Medical Assistance Services, May 11, 2016.
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Anchorage: Alaska Department of Health and Social Services. http://dhss.alaska.gov/dhcs/ Documents/PDF/Recipient-Handbook.pdf (accessed June 30, 2016)
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New Castle: Delaware Health and Social Services. http://www.dmap.state.de.us/downloads/manuals/ General.Policy.Manual.20150714.pdf (accessed June 30, 2016)
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2011a. Chapter 20: Eye examinations/vision and hearing.
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Indianapolis: Indiana Family & Social Services. http://provider.indianamedicaid.com/media/155592/vision%20 services.pdf (accessed April 8, 2016)
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2015b. Routine eye examination and visual aids.
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Albany: New York State Medicaid Program. https://www.emedny.org/ProviderManuals/VisionCare/ PDFS/VisionCare_Policy_Guidelines.pdf (accessed May 23, 2016)
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2008. South Carolina Healthy Connections Medicaid program.
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Olym pia: Washington State Health Care Authority. http://www.hca.wa.gov/medicaid/billing/ documents/guides/vision_hardware_for_kids_bi.pdf (accessed April 8, 2016)
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