NIH Study Reveals Significant Gaps in Medicaid Coverage for Adult Vision Care
A recent study funded by the National Institutes of Health (NIH) has uncovered significant disparities in Medicaid coverage for adult vision care across the United States. The study, which analyzed 2022-23 state policies, reveals that millions of Medicaid enrollees lack access to basic vision services, such as routine eye exams and eyeglasses, potentially contributing to widespread vision impairment and related health issues.
According to the research, published in Health Affairs, 6.5 million Medicaid enrollees (12%) reside in states where routine adult eye exams are not covered. Even more concerning, 14.6 million enrollees (27%) live in states without coverage for eyeglasses, according to the NIH. The study is one of the first to provide a comprehensive state-by-state analysis of adult Medicaid benefits for basic vision services, shedding light on the uneven landscape of healthcare access in the U.S.
The analysis, which reviewed Medicaid enrollee data from 2020 and coverage policies from 2022-23, revealed wide variation in state-level coverage for adults. For example, 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. Seven states—Arizona, Idaho, New Mexico, Oklahoma, Tennessee, West Virginia, and Wyoming—offer no coverage for either exams or glasses under both fee-for-service and managed care policies. Additionally, 35 states do not cover low vision aids, such as magnifiers and loupes, leaving many, particularly older adults, without necessary tools to manage their vision loss.
Even in states where vision care services are covered, barriers such as copays and restrictive policies can prevent enrollees from accessing the care they need, the NIH noted in a news release. The study notes that two-thirds of states require enrollees to share the cost of vision care, which can be prohibitively expensive for those living at or below the federal poverty level. In Maine, for example, glasses are covered only once per lifetime and only for individuals with an unusually strong prescription.
"Our study clearly shows that there are opportunities to expand coverage of routine vision services at the state level," said Dr. Brandy Lipton, associate professor of health, society, and behavior at the University of California Irvine and lead author of the study. "Based on previous research, we expect more generous coverage would reduce rates of vision impairment, improve quality of life, and promote health equity," she said.
The study also highlights the broader implications of vision impairment, which can lead to an increased risk of falls, hip fractures, social isolation, depression, cognitive impairment, and even mortality. With the aging U.S. population, the number of individuals with vision impairment is expected to double by 2050, underscoring the urgent need for expanded access to vision care.
The study was supported by NEI grant (R01EY033746).