The Affordable Care Act (ACA) is a point of access for many patients who need eye care services, from children’s vision care to adults managing chronic illnesses as they age. In some states, Medicaid provides these services through Medicaid expansion. As Congress continues to debate the ACA, Prevent Blindness advocates that the law’s “essential health benefits,” which includes children’s vision services as well as chronic disease management services, remain as defined under the ACA and that Medicaid continues to be available to those who rely on the program for their vision health.
As Americans age, many will experience a decline in vision and complications to their eye health due to chronic disease. Seniors over the age of 65 largely rely on Medicare for numerous healthcare needs; however, Medicare does not currently provide an adequate level of vision and eye health services necessary for maintaining good vision or slowing the progression of age-related eye disease. Providing a comprehensive eye exam as part of the “Welcome to Medicare” benefit and removing barriers for beneficiaries for seniors to utilize Medicare for their vision and eye health needs is a powerful opportunity to reduce costs to both the program and seniors, improve patient outcomes in the Medicare program, and ensure that aging Americans maintain their sight for as long as possible. In addition, Prevent Blindness advocates for the Medicare program to include coverage for low vision devices as well as services to assist those living with low vision.
Medicaid was originally built to ensure that Americans who face significant hardships can still access the healthcare they need. In 2010, with the passage of the Patient Protection and Affordable Care Act, several states expanded the program as an additional pathway to insurance. Currently, several states offer vision care services to adults and children who rely on Medicaid for prevention and care management services. Prevent Blindness continues its advocacy for the inclusion of vision and eye health services as well as program eligibility to be expanded for both adults and children as a manner of improving access to care. In addition, to both improve the Medicaid program and ensure that children who fail their EPSDT (Early and Periodic Screening Diagnosis and Treatment) vision screening receive the proper follow-up in order to detect problems that could lead to permanent vision impairment, we advocate that providers in the Medicaid and Children’s Health Insurance Program (CHIP) follow the recommendations of the Department Health and Human Services Office of the Inspector General and report results and completion of a referral.
Improvements to biomedical technology have vastly improved Americans’ collective vision and eye health. However, even with numerous technological advancements, 4 out of 5 incidents of vision loss are preventable. Federal policy has a number of powerful mechanisms to promote the research, development, distribution, treatment, and accessibility for eye care consumers. Prevent Blindness supports the concepts included in the 21st Century Cures Act for basic scientific research, streamlining the drug and device development process, and using new and innovative avenues to improve treatment and care delivery. As well, we advocate for the continuation of a robust research pipeline at the National Eye Institute, the National Science Foundation, and the Department of Defense to ensure that research findings go swiftly from bench to bedside. Above all, we continue to advocate that patients have access to safe, effective, and affordable medical care, treatments, and therapies.
Vision problems require both preventive efforts as well as health promotion and education. To accomplish these goals, the Centers for Disease Control and Prevention’s Vision Health Initiative and Glaucoma Project provide patients with the information needed to prioritize their eye health and seek appropriate treatments. In order to stem the tide of this common but often overlooked chronic condition, Prevent Blindness continues its work advocating that Congress make critical investments to these programs to control long-term costs for preventable vision impairment.
Your Story Can Help Improve Vision Treatment for All Americans
Has your eye doctor prescribed a medication or a treatment to address your eye health condition, only for you to learn that your insurance company requires you to first try a generally cheaper and possibly less effective drug before they will approve the one you and your doctor have determined would be the best one to treat your eye disease? This policy, which is often referred to as “fail first,” is called Step Therapy, and it may delay your access to sight-saving treatments.Learn More