Project Title: Evaluation of Availability and Cost of Optometrist Services to Enhance Access for Medicaid Patients

Category: Vision, Medicaid

Background: Colorado Medicaid Vision Codes have not been reviewed in over 40 years. Currently, Medicaid reimburses optometrists roughly 19% of care expenses, making it financially difficult for many doctors to accept Medicaid patients. Some of those who do accept these patients must severely restrict the number they treat.

Objective: To determine the financial impact of a reimbursement increase on the overall Medicaid budget, the number of optometrists, and access to vision care services.

Methodology: Vision Care used APCD Medicaid price and utilization data to calculate how a modest increase might impact the overall budget versus the number of optometrists available, especially in rural Colorado.

Data Analyzed: Vision services utilization and procedure code trends over 3 years

Results: The Colorado Optometric Association made a presentation to the Department of Health Care Policy and Financing regarding the incredibly low Medicaid reimbursement rates. They showed that the lack of participating vision care providers is due to their inability to recover the minimum chair cost (price per patient per hour).

Based on data presented, the Department made a recommendation to the Governor’s Office of State Planning and Budget to increase the reimbursement rates for certain vision codes. This budget increase was then recommended to the State Legislature through the Joint Budget Committee where it was approved by both the House and Senate. These increased rates became effective July 1, 2014 and the number of participating vision care providers has increased especially, in underserved areas of the state.

Vision care providers are among the first to diagnose diabetes, hypertension, glaucoma, and macular degeneration. Increased access to care allows providers to diagnose these conditions earlier, which should translate into total cost of care costs and greater quality of life for patients.

Colorado Optometric Association

  • Type of Report: Custom Report
  • Date Fulfilled: June 26, 2013