Medi-Cal Re-instates Optometry Services

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

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.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.