California kids are going without vision care, and the problem is getting worse - Sacramento News & Review

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California kids are going without vision care, and the problem is getting worse Sacramento News & Review

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[Michael Molamphy]

California kids are going without vision care, and the problem is getting worse Sacramento News & Review

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great catch. a huge deficiency in the CA vision care for kids. I'll be contacting my state reps.

 

[Mike Ware OD]

great catch. a huge deficiency in the CA vision care for kids. I'll be contacting my state reps.

The article states that only about 10% of ODs in California accept Medicaid due to low reimbursement rates. One would think that should be a pretty damn strong indicator to state representatives that reimbursements need to be increased dramatically.

 

[Helfon Hanono]

The article states that only about 10% of ODs in California accept Medicaid due to low reimbursement rates. One would think that should be a pretty damn strong indicator to state representatives that reimbursements need to be increased dramatically.

After inflation in the last 2 years, we had to raise our payroll at least 20%. We stopped taking medi-cal and our gross and net went up. I wish I had stopped taking it years ago.
They pay $40.00 for an exam and $40 dispensing fee. On top of that at we had at least a 25 to 30% no show per day.
I do not know any one in my area that is still taking medi-cal.

 

[Helfon Hanono]

After inflation in the last 2 years, we had to raise our payroll at least 20%. We stopped taking medi-cal and our gross and net went up. I wish I had stopped taking it years ago.
They pay $40.00 for an exam and $40 dispensing fee. On top of that at we had at least a 25 to 30% no show per day.
I do not know any one in my area that is still taking medi-cal.

By the way, 50% of children 0-19 in California are on medi-cal. Very sad the compensation doctors get especially with all the waste and fraud in this state. I wish we had a non bias press. This would be fixed quickly if the public knew what is going on.

 

[Michael Molamphy]

The article states that only about 10% of ODs in California accept Medicaid due to low reimbursement rates. One would think that should be a pretty damn strong indicator to state representatives that reimbursements need to be increased dramatically.

Exactly. I will write a strong letter to our state reps, probably will be ignored. I think they were planning to raise rates, then reneged on it. There are few drs. here who accept Medicaid. I still do, for now. For the kids.

 

[Mike Ware OD]

Exactly. I will write a strong letter to our state reps, probably will be ignored. I think they were planning to raise rates, then reneged on it. There are few drs. here who accept Medicaid. I still do, for now. For the kids.

This is just crazy to me. When 90% of optometrists don't accept Medicaid because the reimbursements are so poor that leaves tens of millions of kids without visual correction in California.

Its baffling how this has been allowed to go on for so long in a state with as much money as California. Even brokeass Mississippi pays well on Medicaid and most every doctor here accepts it.

 

[Michael Molamphy]

This is just crazy to me. When 90% of optometrists don't accept Medicaid because the reimbursements are so poor that leaves tens of millions of kids without visual correction in California.

Its baffling how this has been allowed to go on for so long in a state with as much money as California. Even brokeass Mississippi pays well on Medicaid and most every doctor here accepts it.

A patient told me only 2 offices accept MediCal here; thats about 5% of offices.

 

[Michael Molamphy]

It's hard to answer without getting political but here goes. As you probably know, California is basically a one party state. Democrats control 75% of the State senate and assembly. The waste and fraud in this state is beyond comprehension. The liberal press does not report any of this so it just continues knowing they will not be held accountable.

It is incomprehensible knowing how few optometrist take medi-cal, and the main reason is compensation to the doctor, and they could care less.

They pay for transgender surgeries for prisoners, unemployment fraud approximately 50 billion due to failure to verify identities, 128 billion for high-speed rail authority that is still not finished and probably never will, 200 million investment in mental health programs and only 22 yes 22 residents were treated in four years. I could go on. Look it up.
They could care less about the poor because they know no matter what they will be elected. Especially for governor.

Unfortunately the press is quiet on all this. Shameless.

I have seen most of this in the news.The mainstream media/ press is not "liberal. ". I agree on the rail disaster. Strongly against transgender surgery for inmates.

 

[Derrick Randall]

VSP just announced they are coming in and taking over the "Vision" portion of one of the contracted Medicaid plans. Looks like they plan on paying ~15% less than the original Medicaid plan which was already not great. So I'm sure there will be even less providers than there were before. What a great business strategy "How about we manage the Medicaid.....but just pay less."

 

[Michael Molamphy]

VSP just announced they are coming in and taking over the "Vision" portion of one of the contracted Medicaid plans. Looks like they plan on paying ~15% less than the original Medicaid plan which was already not great. So I'm sure there will be even less providers than there were before. What a great business strategy "How about we manage the Medicaid.....but just pay less."

where is the announcement? thx.

 

[Derrick Randall]

where is the announcement? thx.

Sorry, this was just in my home state of Iowa.

 

[Kenneth C Dzubey OD]

VSP just announced they are coming in and taking over the "Vision" portion of one of the contracted Medicaid plans. Looks like they plan on paying ~15% less than the original Medicaid plan which was already not great. So I'm sure there will be even less providers than there were before. What a great business strategy "How about we manage the Medicaid.....but just pay less."

They took over the Molina Medicaid in TX. Offices could opt-out though.
....that was the first thing i did....below was their reply....

******
Hello Dr. Dzubey,

Thank you for reaching out to VSP Provider Network Development and thank you for your response.

We have opted the practice out of the Medicaid Network.

Should your office decide to participate in the future, we would be delighted to have you join the network.

We hope you have a great day.

Best,

 

[Jeffrey S. Filandro]

Maryland has the $45 or $50 medicaid plans.

Now they have the $45 Adult Medicaid plan.

For the greater good, OD’s are asked to take one for the team.

Our eyeMD friends have decided to employ OD’s to take one for their team.

However, because OD’s would universally bill medically to get paid more, most kids do not have medical coverage available by OD’s.

One visit, $45, NEXT!

 

[Steven Faith OD FAAO]

This is just crazy to me. When 90% of optometrists don't accept Medicaid because the reimbursements are so poor that leaves tens of millions of kids without visual correction in California.

Its baffling how this has been allowed to go on for so long in a state with as much money as California. Even brokeass Mississippi pays well on Medicaid and most every doctor here accepts it.

Mike, what's crazy to me is that many of the same ODs who are not MediCal providers in CA due to the "low reimbursement" accept, Davis, Spectera, MES, Superior, etc. They won't take the $40 exam fee from those in their communities who truly need their care, but accept it from the "Tesla driving-$15 latte carrying" Davis patient who won't spend anything over their "covered" benefits.

Our office is one of the 10% that accept MediCal in CA. In 2025 we did 12,205 comprehensive exams and 946 of these were MediCal.

Why?

- Marketing - not all MediCal patients have Medical friends or family in our community. They still talk about how good the care was they received at our office at their schools, church, etc.
- Demographics - currently, we have many 26-30 yo MediCal pts who went off their parents' coverage and went to Covered CA to get benefits since their "start-up" or current employer doesn't have any benefits. They want cheap medical coverage since they are healthy and don't need the other "stuff". But, guess what? They just paid out of pocket for their years' supply of CLs since they have a well paying job but no vision insurance at the moment. Where do you think they will go when their startup goes public or has vision care?
- Scheduling - of course we don't schedule MediCal patients in the same manner as the other patients that generate more income per exam. There are simple adjustments to schedules to see these patients without affecting our other income streams. Yes, there are the attendance aspects of this population that we all have known for many years. But put your business hat on and figure out how to see these patients considering these traits.
- Eyewear - MediCal in CA has limitations on eyewear and the lab used for these jobs. Many patients don't like their MediCal options and have no problem using our "Costco Package" that is a Modern Frame + SVL/BFL for $85/$120 we have through Hoya. This currently is about 50% of this population.
- Medical Coverage - if we find a medical based Dx during their initial visit (which many have), they now are a medical based MediCal patient and we can evaluate and treat their conditions like any other medical condition we see - and get paid by MediCal. These patients now actually generate more annual income for our office than their "I want what is covered" routine VSP patients that we can't get rid of sometimes.

And finally, it is simply the right thing to do. None of our docs want to go to their kids' school play and realize that some 20% of the kids at this school have uncorrected vision issues that are going undiagnosed because our office won't see their families because they are on MediCal.

It gets my goat every time I see a 35 yo patient who is an anisometropic amblyopic who didn't get glasses as a child because their family was on MediCal and they didn't get an eye exam until they were in their twenties when they got a job with benefits.

Geez, what's wrong with us...?

(Yeah, little sprinkle of guilt inserted on purpose there)

 

[Michael Molamphy]

Mike, what's crazy to me is that many of the same ODs who are not MediCal providers in CA due to the "low reimbursement" accept, Davis, Spectera, MES, Superior, etc. They won't take the $40 exam fee from those in their communities who truly need their care, but accept it from the "Tesla driving-$15 latte carrying" Davis patient who won't spend anything over their "covered" benefits.

Our office is one of the 10% that accept MediCal in CA. In 2025 we did 12,205 comprehensive exams and 946 of these were MediCal.

Why?

- Marketing - not all MediCal patients have Medical friends or family in our community. They still talk about how good the care was they received at our office at their schools, church, etc.
- Demographics - currently, we have many 26-30 yo MediCal pts who went off their parents' coverage and went to Covered CA to get benefits since their "start-up" or current employer doesn't have any benefits. They want cheap medical coverage since they are healthy and don't need the other "stuff". But, guess what? They just paid out of pocket for their years' supply of CLs since they have a well paying job but no vision insurance at the moment. Where do you think they will go when their startup goes public or has vision care?
- Scheduling - of course we don't schedule MediCal patients in the same manner as the other patients that generate more income per exam. There are simple adjustments to schedules to see these patients without affecting our other income streams. Yes, there are the attendance aspects of this population that we all have known for many years. But put your business hat on and figure out how to see these patients considering these traits.
- Eyewear - MediCal in CA has limitations on eyewear and the lab used for these jobs. Many patients don't like their MediCal options and have no problem using our "Costco Package" that is a Modern Frame + SVL/BFL for $85/$120 we have through Hoya. This currently is about 50% of this population.
- Medical Coverage - if we find a medical based Dx during their initial visit (which many have), they now are a medical based MediCal patient and we can evaluate and treat their conditions like any other medical condition we see - and get paid by MediCal. These patients now actually generate more annual income for our office than their "I want what is covered" routine VSP patients that we can't get rid of sometimes.

And finally, it is simply the right thing to do. None of our docs want to go to their kids' school play and realize that some 20% of the kids at this school have uncorrected vision issues that are going undiagnosed because our office won't see their families because they are on MediCal.

It gets my goat every time I see a 35 yo patient who is an anisometropic amblyopic who didn't get glasses as a child because their family was on MediCal and they didn't get an eye exam until they were in their twenties when they got a job with benefits.

Geez, what's wrong with us...?

(Yeah, little sprinkle of guilt inserted on purpose there)

Just excellent. one of my very first MCal patients, a young woman, came in and paid for the most expensive SV eyeglasses I had. And she was not well dressed. Some of these patients have cash$$$.

 

[Daniel Navarro]

Mike, what's crazy to me is that many of the same ODs who are not MediCal providers in CA due to the "low reimbursement" accept, Davis, Spectera, MES, Superior, etc. They won't take the $40 exam fee from those in their communities who truly need their care, but accept it from the "Tesla driving-$15 latte carrying" Davis patient who won't spend anything over their "covered" benefits.

Our office is one of the 10% that accept MediCal in CA. In 2025 we did 12,205 comprehensive exams and 946 of these were MediCal.

Why?

- Marketing - not all MediCal patients have Medical friends or family in our community. They still talk about how good the care was they received at our office at their schools, church, etc.
- Demographics - currently, we have many 26-30 yo MediCal pts who went off their parents' coverage and went to Covered CA to get benefits since their "start-up" or current employer doesn't have any benefits. They want cheap medical coverage since they are healthy and don't need the other "stuff". But, guess what? They just paid out of pocket for their years' supply of CLs since they have a well paying job but no vision insurance at the moment. Where do you think they will go when their startup goes public or has vision care?
- Scheduling - of course we don't schedule MediCal patients in the same manner as the other patients that generate more income per exam. There are simple adjustments to schedules to see these patients without affecting our other income streams. Yes, there are the attendance aspects of this population that we all have known for many years. But put your business hat on and figure out how to see these patients considering these traits.
- Eyewear - MediCal in CA has limitations on eyewear and the lab used for these jobs. Many patients don't like their MediCal options and have no problem using our "Costco Package" that is a Modern Frame + SVL/BFL for $85/$120 we have through Hoya. This currently is about 50% of this population.
- Medical Coverage - if we find a medical based Dx during their initial visit (which many have), they now are a medical based MediCal patient and we can evaluate and treat their conditions like any other medical condition we see - and get paid by MediCal. These patients now actually generate more annual income for our office than their "I want what is covered" routine VSP patients that we can't get rid of sometimes.

And finally, it is simply the right thing to do. None of our docs want to go to their kids' school play and realize that some 20% of the kids at this school have uncorrected vision issues that are going undiagnosed because our office won't see their families because they are on MediCal.

It gets my goat every time I see a 35 yo patient who is an anisometropic amblyopic who didn't get glasses as a child because their family was on MediCal and they didn't get an eye exam until they were in their twenties when they got a job with benefits.

Geez, what's wrong with us...?

(Yeah, little sprinkle of guilt inserted on purpose there)

We see a lot of Medi_Cal patients who are kids and a good amount of them break their glasses and the parents do not bother to replace them. Most of these kidshave moderate to high hyperopia with a fair amount of cylinder.

 

[Jenifer Ambler]

We see a lot of Medi_Cal patients who are kids and a good amount of them break their glasses and the parents do not bother to replace them. Most of these kidshave moderate to high hyperopia with a fair amount of cylinder.

Same in my state. Medicaid covers replacements, but it's a combination of parents not knowing or remembering, parents not having their sh** together enough to order, and parents "teaching the kid a lesson" by making them go without.

Fortunately, we've had a some good school nurses on our side. For a few kids, the nurse calls us to order a replacement as soon as the kid is seen without glasses. For a couple of kids, we'd order yet another spare and the nurse would keep it in the school office; as soon as that one was handed out, we'd order another.