In July 2009, the state of California, under tight budget constraints, eliminated all optometry and optical services for adults under Medi-Cal, the state’s Medicaid health care program.
Optometrist Robert Shapiro estimates that his practice in downtown Los Angeles has lost 20% of its net income since the Medi-Cal cutback last July. “These past 10 months without Medi-Cal have been tough for both me and my patients. Fortunately, we’ve survived better than expected by lowering our fees and still being able to see Medicare patients,” he says.
Adult dental and psychology services—which, like optometry, are considered “optional services”—were eliminated as well. Physicians’ services—which are not considered “optional”—were not eliminated.
But the Governor’s 2010-2011 Budget, if approved, would reinstate $1.3 million of Medi-Cal optometry services for adults.
Why the change? The state law doesn’t seem to comply with federal regulations, found in the Social Security Act, that equate optometric services with physicians’ services. The state policy needs to be rescinded to comply with federal law.
Yet, even if the proposed budget is approved, that won’t fix the entire Medi-Cal shortfall.
“The proposed restoration is for examination services only, not optical benefits,” Dr. Shapiro says. “I’ve found that many Medicare patients, even if their examination is covered, decide to forgo the examination if they can’t get glasses. I expect that will be the same with Medi-Cal. My prediction is that it will marginally improve my income and facilitate treating some needy patients, but that there will not be a wholesale change in patient load from the current level.”