A Longitudinal Database of Medicaid Routine Vision Coverage Policies, 2000-2023

• In Event: Tracking policy changes and health impacts of access to specific forms of care among Medicaid populations

Abstract

Routine vision services including eye exams and glasses are an optional adult benefit in state Medicaid programs. States have added and dropped these benefits over time. Furthermore, states that offer vision benefits may choose how frequently to provide coverage and whether to charge copays or dispensing fees, among other restrictions. While some sources document state-level coverage information in select years (e.g., KFF), there is no comprehensive longitudinal database describing these policies. The lack of reliable state-by-year level data limits research on the effect of vision benefits on outcomes and the role that vision benefits play as a financial lever that is used by states to manage their Medicaid programs.

We reviewed state codes and regulations, state plan amendments, provider manuals, state website captures, and KFF databases and reports to extract information on state-level routine vision coverage from 2000 to 2023. Two researchers independently coded the following information on adult coverage, if available, from each source: (1) whether and how often routine eye exams were provided, (2) whether and how often eyeglasses for correction of refractive error were provided, (3) minimum diopter correction requirements for eyeglasses, (4) whether replacements were provided if eyeglasses were lost or broken, (5) whether copays/dispensing fees were required for routine eye exams and/or eyeglasses, and (6) whether low vision aids (e.g., magnifiers, loupe) were provided when necessary to correct vision. Discrepancies in the coding for each source were evaluated by a third reviewer and resolved through group discussion.

We found that in 2023, 40 states covered routine eye exams and 32 states covered glasses. Among states that covered routine vision services, 26 states charged a copay/dispensing fee, 19 states provided replacements for lost or broken glasses, and 21 states had a minimum diopter requirement for providing glasses. In addition, 19 states covered low vision aids.

During the 2000-2023 period, 4 states added or dropped routine eye exam benefits only, 4 states added or dropped glasses benefits only, and 6 states added or dropped both routine eye exams and glasses benefits. Among states that did not add or drop routine vision services, 10 states changed the frequency with which vision benefits were provided.

To demonstrate the empirical utility of these data, we link the policy database with data from the National Health Interview Survey and provide updated estimates on the association between Medicaid routine vision benefits and adult eye care access and utilization. The database will be made available to researchers in the future to enable further work in this understudied area.

Author

• Michel H. H. Boudreaux, University of Maryland, College Park
  Presenting Author