Reversal in sight? State rethinks decision to quit providing glasses to needy adults

Willie Posey of Oakland takes great care of his three-year-old glasses. He needs to keep them as long as he can because Medi-Cal, the state’s health plan for low-income Californians, stopped covering lenses or frames—and he says he can’t afford to pay out-of-pocket again even though he has a new prescription.

“I have to wear glasses all of the time. I’m looking at the TV and I can’t make out what’s going on without glasses,” said Posey, 79, who bought his current pair at Costco. “Even when I have them on I’m not seeing clearly anymore.”

Posey says he’s old so he’ll make do. But the retired UC Berkeley worker feels bad for younger people who need glasses to work, especially if they do construction or operate dangerous machinery.

The question in the Capitol now: Is it time to restore several health benefits the state took from Medi-Cal recipients a decade ago, including the clearer vision that eyeglasses provide?

In 2009, state lawmakers—confronting a recession and budget shortfalls—opted to save state money by eliminating several Medi-Cal benefits, mainly for adults, that the federal government didn’t specifically require. The list of lost services included dental, optical, podiatry, chiropractic, audiology, acupuncture, speech therapy—even incontinence washes and creams.

As California finances bounced back, the state restored dental benefits in 2013 and acupuncture in 2016.

This year advocates are pushing to restore the rest of the lost coverage, with a particular push for eyeglasses.

Currently Medi-Cal covers eye exams, evaluations, screenings and measurements for eyeglass prescriptions. It covers eyeglasses, lenses and other low-vision devices only for people under 21, seniors in nursing homes and pregnant women.

Two years ago, the Legislature called for the eyeglasses benefit to be restored in 2020, contingent on legislative funding. Advocates saw this statement—in a budget “trailer bill” agreed upon by the Legislature and former Gov. Jerry Brown—as a commitment to bring the benefit back.

But new Gov. Gavin Newsom failed to include restoration of the benefit in his initial budget proposal. He could include it in a revised budget he’ll submit next month, or the Legislature could decide to champion the cause in budget negotiations with the governor. 

“These are critical benefits that people are going without,” said Linda Nguy, policy advocate for the Western Center on Law and Poverty. “For nearly ten years people have done without, and that’s a long time.”

The California Optometric Association used national data to estimate that about 2 million Medi-Cal recipients ages 21 to 64 need glasses or lenses.

The state cost to restore all the outstanding optional benefits is $40.5 million annually—including  $26 million for optical and $4.6 million for podiatry.

The actual cost of the benefits is much higher, but the difference would be paid by the federal government, which splits the bill for Medi-Cal with the state.

“We are leaving federal funds on the table by not doing that, but it does require a state investment,” said Elia Gallardo, director of policy research for the Insure the Uninsured Project, a non-partisan research organization that provides policy analysis and evaluation to stakeholders.

Experts also note that because the Affordable Care Act expanded Medi-Cal to a larger group of Californians, the cost is higher to cover all of those individuals.

And that’s a budget consideration, said Nadereh Pourat, associate director at the UCLA Center for Health Policy Research. Add to those rolls the 19-26-year-old undocumented immigrants the governor wants to cover with Medi-Cal, and costs would rise further.

“Everything is a worthwhile cause, but there is a competition for how to spend money,” Pourat said. “You have what you pay out, how many people you cover and what benefits you offer, and you have to balance the three of them out to do everything you want to do.”

The push for the promise of optical benefits hinges on that agreement in the 2017 budget to bring back optical services in 2020. The state Department of Health Care Services notes that the 2017 budget bill “restored” services for optometrists and opticians, but that it is “contingent upon the Legislature allocating funding.”

And backed by the California Podiatry Association, GOP Assemblyman Heath Flora of Ripon asked an Assembly Budget subcommittee to restore foot care—noting the prevalence of diabetes in California, which absent proper care can lead to foot amputations. Because the Legislature and governor are negotiating the budget for the next fiscal year, the assemblyman and the advocates are essentially requesting the lawmakers on the budget committee negotiate for these items to be included in the final state budget.

Experts say the 2017 bill language could be construed as a statement of intent from one Legislature to another, or a punt to a new Democratic Gov. Gavin Newsom because former Gov. Jerry Brown was so reluctant to take on more general fund spending.

“They knew we would have a new governor who would be more amenable to certain things,” said Shannon McConville, senior research associate at the Public Policy Institute of California.

She said it isn’t surprising Newsom didn’t include the restoration in his first budget, which was his opportunity to lay out his own broad plans. There are signs, she said, that he might be open to the restoration because he seems willing to spend more on Medi-Cal, given his other proposals.

“Sometimes I feel like we are penny-wise and pound-foolish with regards to this,” said Democratic Assemblyman Jim Wood of Mendocino, who sits on the committee and supports restoring the benefits.  “It is a life-changing thing for people, the ability to see, to be able to read and then to be able to be a better part of the workforce.”

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