An element in the governor’s proposed changes to Medicaid would do away with vision benefits for adults. But the health consequences of eliminating the benefit can be significant. The Centers for Disease Control notes early detection, diagnosis and treatment can prevent significant loss of vision, and “people with vision loss are more likely to report depression, diabetes, hearing impairment, stroke, falls, cognitive decline and premature death.”
In Kentucky there are an estimated 192,060 people who are either blind or have serious difficulty seeing even when wearing glasses, according to 5 year estimates of the 2014 American Community Survey. This represents roughly 1 in 20 Kentuckians who aren’t in some kind of long-term care facility like a nursing home. On a county level, vision impairment ranges from 1.5 percent in Gallatin county to 12.7 percent in Pike County.
Beyond the fact that vision impairment makes it difficult to read, drive and do many other things necessary to work and go about everyday life, it is also a drain on the economy. A 2004 study estimates that vision impairment (which includes things like cataracts, glaucoma, blindness and other conditions) costs the US $35.4 billion from direct medical costs, other direct costs and productivity losses.
Because diabetic retinopathy —or vision loss from diabetes — is a leading cause of blindness, early detection of diabetes often starts in an optometrist’s office. Other conditions like glaucoma and cataracts are also often detected early during annual vision screenings, before they become more difficult and costly to treat.
The current Medicaid vision benefit in Kentucky is modest, and only covers exams and diagnostic procedures at optometrists and ophthalmologists offices. Glasses (lenses, frames and repairs) are only covered for Kentuckians up to age 21, so most Kentucky adults are still responsible for buying their own eyewear and contacts out of pocket.
In the administration’s waiver proposal, beneficiaries could “earn back” vision (and dental) benefits by completing “specified health-related or community engagement activities.” But evaluations of similar incentive programs in Iowa and Michigan suggest few people likely would earn such incentives, leading to a big drop in the number of people with coverage.
Vision care is an important aspect of public health. Kentucky is better off with an able-bodied workforce, and when preventable conditions that both lead to blindness, and indicate more serious diseases, are caught and treated early. It’s important that the already-limited vision benefit remain part of the Medicaid package in Kentucky.
