Medicaid Eye Exams & Coverage

Medicaid Eye Exams & Coverage
Medicaid coverage for eye exams depends on several factors.

Children

Children up to age 21 are covered under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, which is mandated for all individual state Medicaid programs via the federal government’s Omnibus Budget Reconciliation Act of 1989. Under the law, each state must provide periodic vision exams, diagnoses and treatments as deemed medically necessary. States are required to create “reasonable standards” regarding how often exams must be performed, in consultation with recognized child health care medical organizations.

Adults

Since Medicaid programs are administered individually by each state, not all state programs offer adult eye exams and vision coverage. Some do, with programs that offer similar coverage to the EPSDT program for children under 21. To find out whether or not your state offers coverage, visit the Medicaid Project’s State Medicaid Links page, look up your state, and view the most current information regarding coverage on your state’s page.

Qualifications

While Medicaid is a program meant to cover low-income people who cannot afford health insurance and do not have it provided by an employer, not all low-income people are covered. Assets, resources and excessive medical expenses are evaluated when you apply for Medicaid coverage. Additionally, your state has specific poverty guidelines that are considered when you apply. To check whether you may apply for Medicaid benefits, visit Benefits.gov. For more specific information, contact your state Medicaid office to find out whether you qualify.

Considerations

If an eye exam administered through your Medicaid coverage determines that eyeglasses or other corrective vision measures are necessary, those are also covered by the federal EPSDT program if you are under 21 years of age. As with adult vision coverage, state statutes determine what is covered for adults. Glaucoma treatments, as deemed medically necessary, may also be covered.