Due to California’s budget cuts, several of Medi-Cal’s optional benefits, including optometry services for adult Medi-Cal beneficiaries were excluded from Medi-Cal coverage as of July 1, 2009.
This summer, however, the Department of Health Care Services (DHCS) reinstated optometry services for adult Medi-Cal beneficiaries. (21 years old and over), effective July 26, 2010.
Now, Medi-Cal once again covers the following optometry services:
- Eye exams and office visits
- Refraction test used to determine the eyeglass prescription
- Eye tests used to evaluate the health of the eyes when medically indicated
- Low vision evaluation for the visually impaired
- Contact lens evaluation for those with certain eye diseases
Medi-Cal does not cover:
- Eyeglasses, including repair and replacement
- Contact lenses
- Low vision aids
Exceptions
Medi-Cal does cover both optometry services and eyeglasses and other eye appliances for a few limited categories of beneficiaries. These include:
- Pregnant women and only if medically necessary to prevent harm to the pregnancy
- Children or young adults who are under 21 years old with full-scope Medi-Cal
- Residents of a licensed Skilled Nursing Facility or Intermediate Care Facility, including ICF-Developmentally Disabled, ICF-Habilitative and ICF-Nursing.
Opportunity for Reimbursement for Out-of-Pocket Expenses
As part of the optometry reinstatement, DHCS will reimburse eligible adult Medi-Cal beneficiaries for out-of-pocket expenses up to the Medi-Cal rate paid for covered optometry services incurred while the optometry services were eliminated (basically expenses between July 1, 2009 – July 25, 2010).
Eligible beneficiaries must request reimbursement from DHCS on or before February 1, 2011.
To request reimbursement, Medi-Cal beneficiaries can call or write to:
California Department of Health Care Services
Beneficiary Service Center
P.O. Box 138008
Sacramento, CA 95813-8008
(916) 403-2007
TDD: (916) 635-6491
More information can also be obtained on the DHCS website.
Medi-Cal beneficiaries may also contact their Medi-Cal caseworker for information on how to request a reinstatement for out-of-pocket expenses.
See our Medi-Cal section for more general information on the Medi-Cal program.
