A recent study funded by the National Institutes of Health discovered disparities in Medicaid vision coverage for adults across the United States. Using the 2022-2023 coverage policies for both fee-for-service and managed care programs, the study provided a state-by-state analysis of adult Medicaid benefits for routine eye exams and eyeglasses.

Overall, 6.5 million Medicaid enrollees (12%) lived in states without coverage for routine adult eye exams, and 14.6 million (27%) resided in states without coverage for eyeglasses. Notably, seven states—Arizona, Idaho, New Mexico, Oklahoma, Tennessee, West Virginia, and Wyoming—had no coverage for either eye exams or glasses under both types of programs. In Maine, glasses are only covered once per lifetime and only for individuals with an unusually strong prescription.

In 20 states, fee-for-service Medicaid excludes coverage for glasses, and in 12 of those states, eye exams are not covered either. Furthermore, 35 states lack coverage for low vision aids. In states that do provide vision care, copays and restrictive policies often create obstacles for enrollees, making it challenging to access exams or glasses. In two-thirds of states, enrollees are required to share in the costs.

The lack of coverage for vision services poses risks, particularly for low-income individuals who rely on Medicaid for their health care needs. Eye exams are crucial for the early detection of eye diseases and obtaining prescriptions for glasses to correct refractive errors, the leading cause of vision impairment in the U.S.

Without proper coverage, these individuals may face preventable vision loss, reduced quality of life, and increased health care costs due to complications associated with untreated vision problems, such as increased risks of falls, hip fractures, social isolation, depression, cognitive impairment, and mortality. The number of people with vision impairment is expected to double by 2050 as the population ages. 

“Reducing disparities in vision care is a powerful way to improve quality of life for everyone. This study points to opportunities for expanding coverage to reduce inequities in basic vision care for people with lower incomes,” concluded Michael F. Chiang, M.D. and NEI director in an NIH news release.