The Kentucky Optometric Association (KOA) is displeased by the removal of routine vision benefits to Kentucky adults in the expansion population. As the state’s primary eye health providers, Kentucky optometrists strongly feel the population’s overall health will suffer and the costs to KY’s Medicaid program will only increase.
Value of Routine Eye Care: Eye care plays a crucial role in the monitoring and management of chronic conditions. Systemic conditions, such as diabetes, high cholesterol and hypertension, are often initially discovered during the eye exam. Quite often, individuals are asymptomatic and unaware of these chronic, sometimes life-threatening conditions. It is well-known that Kentucky ranks among the worst in chronic health care. Routine comprehensive eye exams assist in preventing vision loss. Symptoms may not result until a condition is far advanced and the damage is irreparable.
When the administration initially filed its KY HEALTH 1115 Waiver Application in 2016, the KOA expressed its concern with treating these important health services as something a citizen must “earn” and receive through a My Rewards account. Taking away these routine benefits will have substantial adverse impacts: overall health will suffer, patients will delay cost-saving treatment until symptoms arise, and it only creates another hurdle for a vulnerable population to be employed, contributing citizens. Further, the cost of the routine vision benefits to the Kentucky Medicaid Program is far less than 1% of the overall Medicaid budget – any cost savings will pale in comparison to the increased cost to patient health and the increased health care costs to the program.
KOA Not Aware of State Plan Amendment: Despite these ongoing concerns, the KOA was an active and willing partner with the Cabinet during the development of KY HEALTH once the 1115 Waiver Application was approved by CMS. Surprisingly, the KOA only learned of the Cabinet’s April 23rd requested State Plan Amendment when it was publicly reported in July after KY HEALTH was halted in federal court. The amendment filed on April 23rd removed vision coverage from the state Medicaid plan for adults – effective July 1. Despite numerous opportunities – including public hearings and Medicaid meetings where potential benefit reductions were discussed – there was no mention of the specific plan amendment and its impact. Rather than maintaining the “status quo” as contemplated by the court with its denial of KY HEALTH, the adult population is now included in a plan with removed vision benefits.
The KOA is disappointed that these substantial changes were made in this manner.
- The KOA will continue to advocate for patient access to these important health services;
- The KOA will continue working to have these services re-authorized as soon as possible, as CMS and the administration determine the next course of action; and
The KOA will continue to make sure that patients understand all medical vision services remain covered for all populations. The plan amendment removes routine vision services for the adult, able-bodied expansion population only – all other KY Medicaid populations have covered routine vision services.