BROWSE CASE STUDIES Case Studies > Evaluation of Availability and Cost for Optometrist Services to Enhance Access for Medicaid Patients.

Evaluation of Availability and Cost for Optometrist Services to Enhance Access for Medicaid Patients.

June 2013


Providers, Medicaid


Health, Medicaid


Center for Improving Value in Health Care

Background: Colorado Medicaid Vision Codes had not been reviewed in over 40 years. Medicaid reimburses Optometrists roughly 19% of what Medicare pays making it difficult financially for Optometrists to accept Medicaid patients. Many Optometrists who do accept Medicaid must severely restrict the number of patients they see because reimbursement does not cover the cost to provide care. With the expansion of Medicaid, Vision Care used APCD 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, to provide access to vision services.

Goal: Determine financial impact that an increase in reimbursement would have on the overall Medicaid budget and the number of Optometrists and access to vision care services, especially in rural Colorado.

Data Analyzed: Utilization of vision services and procedure code trends over 3 years were evaluated to understand how many doctors were participating in the most utilized codes and procedures.

Results: The Colorado Optometric Association made a presentation to the Department of Health Care Policy and Finance regarding the incredibly low reimbursement rates and the lack of participation of vision care providers due to their inability to meet even the most minimum of chairs costs within their practices. Based on data the Department made a recommendation to the Governor’s Office of State Planning and Budget to increase the reimbursement rates for certain vision codes to 80% of Medicare. 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. Because vision care providers are among the first to diagnose diabetes, hypertension, glaucoma and macular degeneration this has translated into diagnosing these conditions earlier. Earlier diagnosis should translate into less costly care over time and greater quality of life for patients. Having a greater number of participating providers should also translate into shorter travel times for patients.