Medi-Cal fails to protect children’s vision

By Dr. Brian Park and Ted Lempert, especially for CalMatters

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Today in a classroom in California, a teacher writes a math equation on a whiteboard. Later, he or she will show assignment instructions on a projection screen before asking students to read at their desks.

This is largely how learning works. Approximately 80% of what children learn is presented visually. And there is a direct link between vision health and school performance—a link that appears when children reach preschool age.

Yet California lags behind in providing much-needed eye care more than half the state’s childrenwhich are served by Medi-Cal, the state’s version of Medicaid.

A recent report commissioned by the California Optometric Association found that simply 16% of school-age children on Medi-Cal receive basic eye care – which means 5 out of 6 pass without. In 47 of California’s 58 counties, the percentage of children receiving vision care has decreased over the past seven years.

More children more than ever are at risk of being left behind due to undetected and uncorrected visual impairments. For many, objects from a distance appear blurry, and children cannot take in what they cannot see. For others, it takes extra effort to maintain a clear vision of a page in front of them, causing fatigue and discomfort.

Two factors lead to this crisis. First, we experience epidemic of myopiaor myopia. Its prevalence has nearly doubled in the US over the past 30 years. By 2050, it is projected to affect half of the world’s population.

2018 Southern California study found 41.9% of young peoplefrom 5 to 19, were myopic. Environmental factors are thought to play a role – an abundance of activities close to work, early screen time and little time spent outdoors.

Second, and just as troubling, California faces a crisis in access to vision care. Medi-Cal reimbursement rates are so low that it costs more to provide care than what is paid to providers.

California reimbursement for a new patient’s eye exam and refraction is just $47 — third lowest in the nation and less than half the national Medicaid average. The rate has not risen in 25 years.

The effects are predictable: 10 percent of California optometrists have been forced out of the Medi-Cal program in the past two years, and 90 percent say patients report having difficulty finding a Medi-Cal provider.

Although this means that children who need glasses do not get them, thereby risking falling behind in school, the health implications are more pronounced.

Severe myopia increases the risk of serious eye disease; but myopia, treated in time, can slow its progression. In addition, a comprehensive eye exam can detect signs of diabetes and other serious diseases, prompting treatment to be recommended.

The recommended schedule for routine eye care for children is not extensive: once every 6 months, at 3 years, before they enter first grade, and then every year or two thereafter.

These simple, relatively inexpensive interventions can have lifelong benefits. Yet California consistently undervalues ​​this essential health care.

Clearly, Medi-Cal is under increasing pressure. At the national level, abbreviations the will adopted last year cut Medicaid funding by $1 trillion over the next decade and could cause about 12 million people to lose their health insurance.

This makes it all the more important that Medi-Cal remains a mainstay of California’s safety net.

But in the area of ​​children’s eye care, Medi-Cal is not doing its core work; not when only 1 in 6 eligible children receive a basic eye exam over a two-year period.

We must not let children fall behind because of vision problems that can be easily and affordably identified and remedied.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.