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.
CMS recently re-approved the KY HEALTH Medicaid 1115 Waiver. The Waiver is now effective 4/1/2019. The Waiver will require adult, able-bodied individuals within the expansion population to earn “My Rewards” dollars for routine vision care. Since the Waiver application was initially filed in 2016, the KOA has adamantly expressed our concerns:
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.
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.
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.
In addition, the KOA will work with the Administration as much as possible during this transition, including requests to view and see the provider portal before the system is live.
Finally, information should be provided to eligible patients informing them of their ability to accrue My Rewards dollars in the meantime, prior to April 1, 2019. This will hopefully avoid any lapse in care and decrease negative health results.