Medicaid for kids but not adults

[Mizikal]

I work in pediatrics and 80% of the kids we see have medicaid. Over the last few weeks I have had adults coming in with outside scripts wanting me to fill them and of course us their Mediciad. Would it be possible to only take medicaid for people under the age of 21? We don't see patients over that age and I am not sure if I can make the exclusion when it comes to glasses.


I don't want a bunch of adults coming in and ordering or browsing frames for security reasons. We have a lot of kids and need to monitor people that come in. I am uncomfortable just having anybody able to walk in and be around the patients. They also come in to look at the worst times and they require more time then children tend to. I hate making our patients wait while I fill an outside RX.

[MikeAurelius]

I believe the law states that if you take Medicaid for any, you must take it for all. **NOT SURE ON THAT**

I wasn't aware Kansas had signed up for the Medicaid expansion. Did they?

[drk]

It may be possible to limit your practice to pediatrics, however.

[harry a saake]

in NC Medicaid glasses are for kids only and the limit is age 18, most Obama plans ive ever seen also cover kids only on glasses

[wondering]

I'm curious about this as well. My office has has had a policy like this in place for years, they only provide glasses for certain medicaid patients. I question the legality/ethics of it.

[Jubilee]

Look in your contracts to be certain. I know many offices that only will do the exams for MK, and not materials, but they have to be registered with the state in order to do so.

If you are a pediatric only practice, then I believe you can set limits on what you can provide.

[optical24/7]

Who'd want a pediatric only practice when 80% of your patients would be paying with Medicaid?

[braheem24]

All health insurances now cover vision for under 18, I think it would make a wonderful niche for a larger practice who can afford to dedicate 1 building to children only. Capture the adults through the children.

[Jubilee]

Believe it or not, I have a viable business model for being a medicaid mill. If you can control your COGS and know your state's plans in and out, you can make a decent amount. Especially now that the ACA plans have mandated coverage for all kids under 18, that in many cases mimics medicaid. No need for 400+ frame choices. No need to worry about what to stock for FSV. Most orders can be edged in house, and with the right value frame line, you can make a lot more than you can on some of the commercial vision plans. Frame selections would go quick, as would most discussions on options. (There would be some, because a fair amount of those with ACA plans actually will spend some cash if they believe transitions/AR/etc is worth it. Adults will pay to upgrade to pals..)

Offer a warranty for $50 that would replace the eyewear one time if something happened to it in the next year. This would more than cover your COGs for most sets. Give the parents a bit of piece of mind.. and be a hell of a lot simpler than the current set up we have.

Plus you can still bill medicaid for medical. So bring on the amblyopes, red eyes, diabetics, etc..

Exams pay more the Eyemed..

Oh, and you can negotiate on some of those contracts when other 3rd party companies are involved.

[dustmousejes]

I don't know about other parts of NC, but in northeastern NC, Medicaid glasses are available for anyone UNDER 21 (20 and younger). It used to be, until October 2011, that adults were eligible as well. No longer. I don't know about harry a saake, but we've never had any problem filing or getting payment for those 19 and 20 years of age who are eligible (ie: its been a year and a day since their last dispense, and they are not on MCD for pregnancy for anything like that)..... Meanwhile in PA, neither of the places I worked ever took Medicaid, for anyone. For the most part, kids either had CHIP or a voucher.