BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1361 (Nielsen) - Medi-Cal: eyeglasses
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|Version: April 19, 2016 |Policy Vote: HEALTH 9 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: May 16, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: SB 1361 would restore coverage for eyeglass for adult
Medi-Cal beneficiaries.
Fiscal
Impact:
One-time costs, likely in the low hundreds of thousands, for
the Department of Health Care services to gain federal
approval for the expanded benefit and make required system
changes (General Fund and federal funds).
Ongoing costs of $70 million per year to provide eye glasses
to qualifying Medi-Cal beneficiaries ($20 million General
Fund, $50 million federal funds). Based on the utilization
rate for eyeglasses amongst Medi-Cal eligible adults before
the benefit was eliminated, the Department estimates that
about 14% of adult beneficiaries will receive a pair of
glasses each year.
Likely ongoing costs in the tens of millions per year for
additional eye exams by Medi-Cal eligible adults (about 30%
SB 1361 (Nielsen) Page 1 of
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General Fund and 70% federal funds). Under current law, adult
Medi-Cal enrollees are eligible for eye exam coverage.
However, only about 8% of adult Medi-Cal beneficiaries get an
eye exam each year, most likely because the program does not
pay for eye glasses. A recent study indicated that people are
twice as likely to get a comprehensive eye exam if their
insurance provides coverage for eye glasses. If 20% of adult
Medi-Cal beneficiaries receive a comprehensive eye exam each
year, the total increase in costs for eye exams would be about
$35 million per year.
Unknown potential future cost savings due to additional eye
exams revealing serious health problems (General Fund and
federal funds). An eye exam can reveal health problems beyond
poor eyesight. To the extent that additional beneficiaries
receive eye exams under the bill, it is possible that some
serious health care issues could be discovered. To some
extent, discovering those conditions early could lead to
earlier intervention and reduced long-term costs. The size of
that impact is unknown.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Federal law requires state Medicaid programs to cover certain
mandatory benefits, such as inpatient hospital services,
physician services, and laboratory services. In addition,
federal law allows states to provide coverage for certain
optional services, such as prescription drugs, dental services,
and eyeglasses. Under current law, the state covers most
optional benefits, with some exceptions. As part of the 2009
Budget Act, certain optional Medi-Cal benefits for adults were
eliminated - including adult dental services, chiropractic
services, optometry services, eye glasses (and other eye
appliances), and psychology services. Since that time, several
of those optional benefits have been reinstated including adult
dental services, psychological services, and eye exams.
SB 1361 (Nielsen) Page 2 of
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Proposed Law:
SB 1361 would restore coverage for eyeglass for adult Medi-Cal
beneficiaries. The benefit would be limited to one pair of
eyeglasses every two years for individuals over 21 years of age
whose uncorrected visual acuity is less than 20/40. The bill
would only be implemented to the extent that federal funds are
available.
Staff
Comments: While eye exams are currently a covered benefit for
adult Medi-Cal beneficiaries, utilization of those services is
only about 8%. Without the ability to have eyeglasses covered by
Medi-Cal, many enrollees elect not to have an eye exam. Under
the bill, it is likely that utilization of eye exam services
would increase, both for individuals who would be eligible for a
pair of eyeglasses and those who would not be, but who have some
concern about their vision.
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