Medicaid Eyewear Rates

[OptiJim]

I am attempting to put together a comparasion of States' Medicaid Vision Program rates for fitting fees and hardware.

If anyone knows of this informations existence, I would appreciate a steering in the right direction.

I am looking for answers to the following questions:

1. What is the average fitting fee paid to dispense Medicaid eyewear in your State?
2. What is the average price/reimbursement Medicaid pays for hardware(eyeglasses) in your State? ( I already have info for Washington State)

Once we have put this information together (if it currently doesn't exist) I will make this available to those who would be interested.

Thank you in advance for your help and Happy Holidays to you and your families.

OptiJim

[GOS_Queen]

Oregon pays us $35 for the fitting fee.

The lab work is done thru a lab and I'm not sure what they are paid.

HTH

[Uilleann]

Simple:

Next.
To.
Nothing.

:)

[orangezero]

Illinois is right around $28 (and was $8 just a few short years ago). Demo frames are provided by the state. Upgrades are not available unless the patient pays out of pocket for everything.

However, we do have some which somehow get fabricated but we never get reimbursed. So the average is somewhat less than $28.

I'd be interested to know the totals and averages of all the states after you gather all the info.

[Jubilee]

The state of Indiana doesn't pay a fitting fee. We get paid based upon the rx and materials used.

Starting Jan 1, they will cover poly for everyone 18 and under. The reimbursement rate is $38.07 per lens. The frame reimbursement is $20.00. Plastic V2100 is $24.42 per lens.

Scratch coat, poly adults, pals, not covered. However the patient can pay the upgrade costs. On frames, if its outside their allowance, patient pays all the cost of the frame.

Some silly things they have is additional codes for adds over 3.25 etc. The problem with these are they aren't additional codes for extra funds (since COGS is higher) they are replacement codes that will get your a different reimbursement amount, but in some cases actually pays you LESS than the normal bread and butter codes.

[Dougfir8]

Much of Oregon has individualized prices for frames, but some Medicaid contracts (in this case, Oregon Health Plan) use a fixed package price. Much is negotiated between various insurance programs which are used by the State to operate the Vision Program. SRC is included. Extras (photochromic, poly, PAL, high index, etc.) are not allowed without a prior approval. The patient could have glasses dispensed, and return later for things like tint or AR coat. Not possible with lens styles or materials!

Many states put this information in the public domain...not allowed to keep it a secret. Go to the State's Medicaid page and look for "Vision".

[DragonLensmanWV]

Uh, people - prices. That's a no-no in general forum. PM him the amounts.

[obxeyeguy]

Uh, people - prices. That's a no-no in general forum. PM him the amounts.

These are state set rates, and in fact should be public information. These are not some super secret numbers, although hard to find, they are available to the public.

[obxeyeguy]

By the way, I get about $31.00 from NC medicaid I believe, I will check in the AM for the exact amount. They make the eyewear, and I have no costs, just a dispensing fee.

[OptiJim]

Uh, people - prices. That's a no-no in general forum. PM him the amounts.

Thank you for keeping us honest Dragon. These are technically not prices, but reimbursements. As Obxeyeguy states, these are public, but usually buried relatively deep or so convoluted that it is hard to interpret. I am really looking for the 20,00ft level. BTW, what are the rates in West Virginia? :)

Most will agree that the amounts paid (at least in comparasion to private insurance or private pay) are considerably less than desired.

Just an FYI for everyone interested, all States provide Medicaid eyewear to children (21 and under?) but only 26 States are currently providing adult eyewear coverage in some form and with the States operating budgets being what they are I imagine the adult portion is being considered for termination in many instances.

Happy Holidays all!!

[Tony_Butler]

I am attempting to put together a comparasion of States' Medicaid Vision Program rates for fitting fees and hardware.

If anyone knows of this informations existence, I would appreciate a steering in the right direction.

I am looking for answers to the following questions:

1. What is the average fitting fee paid to dispense Medicaid eyewear in your State?
2. What is the average price/reimbursement Medicaid pays for hardware(eyeglasses) in your State? ( I already have info for Washington State)

Once we have put this information together (if it currently doesn't exist) I will make this available to those who would be interested.

Thank you in advance for your help and Happy Holidays to you and your families.

OptiJim

In Ohio we have many different Medicaid plans. Many of the Medicaid patients have be "out sourced" to Manage Care Options. For the ones that have not "Standard Medicaid" we only get a dispensing fee. Single Vision - $22.44 Bifocal -$27.80 Trifocal - $30.95. Ages 1-20 and 65 + are eligible for material every year with NO COPAY. Ages 21-64 are eligible for material every two years with $1.00 copay.