July 1 marked the end of all optometry and optical services for adults under Medi-Cal, Californias Medicaid health care program. Adult dental and psychology services were eliminated, as well.

Cutting these benefits comes at a critical time. California is in a fiscal emergency. The governor and lawmakers are grappling with a $24 billion deficit. The state government is on the brink of shutting down. State workers face unpaid furloughs. Most programsfor the elderly, schools, universities, libraries, police, firefighters and parksare on the chopping block.

While were acutely aware of the states budget problems, the elimination of the kind of affordable and quality vision care that optometrists provide to Medi-Cal patients with limited resources will have serious consequences, says Hilary Hawthorne, O.D., president of the California Optometric Association.

Under federal Medicaid law, optometrists are not defined as physicians, and their services in California have been deemed optional. However, ophthalmologists, whose physician services are state-mandated, can continue to see adult Medi-Cal patients for eye-related medical services.

But, there are twice as many patients who receive eye examinations from optometrists and are dispensed optical lenses than there are patients receiving similar services provided by ophthalmologists, Dr. Hawthorne says.

For example, Jay H. Messinger, O.D., is the only optometrist in Compton, a city in southern Los Angeles County with a population of nearly 100,000. No ophthalmologists practice there, he says. I estimate 40% of my practice is Medi-Cal adult optometry, bringing in approximately 60% of the revenues of my practice. Of course, all of this ended yesterday [July 1].

Dr. Messinger is equally concerned about how the cutbacks will affect the population he serves, which has high risks for ocular disorders.

Diabetes and hypertension are endemic to the African-American and Latino populations who reside in Compton. These individuals do not have the financial wherewithal to visit an eye care practitioner at their own expense on an ongoing basis, he says. Ever-dwindling emergency room facilities will be overwhelmed attempting to care for patients at late-stage progression of their disorder(s).

Optometrist Robert Shapiro estimates that the patient base of his downtown Los Angeles practice includes between 60% and 70% Medi-Cal patients. In 28 years of practice, I have never faced this problem, so everything is speculation, he says. What is not speculation is that a lot of needy people will be unable to obtain basic eye care, including examinations and glasses. There will be a lot of preventable vision loss because this population has a high incidence of diabetes and glaucoma. And, because they are not being examined and treated in a timely manner, a significant percentage will probably develop irreversible pathology.

Seven out of 10 Californians see an optometrist first for their eye care needs, with many Medi-Cal patients among them, Dr. Hawthorne says. At a time when optometrists are becoming a key entry point into quality and affordable eye and health care for Californians, this roll back of Medi-Cal optometric services is penny wise and pound foolish, she says.

One possible solution: Change the federal law for Medicaid so that optometrists are defined as physicians for the purposes of providing care. To that end, Reps. Jan Schakowsky (D-Ill.) and Ralph Hall (R-Texas) have introduced the Optometric Equity in Medicaid Act (H.R. 2697), a bi-partisan bill that applies the Medicare definition of optometrists as physicians to Medicaid. Soon after its introduction on June 4, the bill was referred to the House Committee on Energy and Commerce.

In the meantime, Dr. Messinger hopes he wont have to cut back hours or begin laying off employees. I certainly did not expect to have to make severe adjustments at this point in my professional career. But, he says, My staff and I are certainly up to the challenge and will be meeting regularly to discuss strategies and adjustments during the coming weeks.

Vol. No: 146:07Issue: 7/15/2009