A pilot program in Los Angeles County to boost the number of kids receiving vision care through the Medi-Cal program appears to have succeeded, even as utilization of such services has seen a sharp decline in recent years.
The mobile vision pilot program operated from January 2015 to June 30 of this year. It relied on vans that visited schools throughout Los Angeles County and provided eye exams to students. The state funded the $2 million program, which was overseen by the county’s two major Medi-Cal insurers, L.A. Care Health Plan and Health Net, in conjunction with the Los Angeles-based charitable organization Vision to Learn.
Vision to Learn’s vans, staffed by an optometrist and an optician, visited more than 1,200 schools in 25 districts throughout L.A. County. More than 31,000 eye exams were provided, and more than 24,000 eyeglasses were fabricated for the children. An optician would return to the school about two weeks after the initial visit with the crafted eyeglasses to perform fittings. The program also replaced more than 500 pairs of eyeglasses that had broken.
“We considered the pilot program an enormous success,” said Damian Carroll, Vision To Learn’s national director and chief of staff.
According to Carroll, the pilot reached out to kids who, while they qualified for vision benefits under the Medi-Cal program, were not receiving those services on a regular basis.
“This can be a hard-to-reach population, and Vision To Learn had a new way of reaching them,” said Alison Klurfeld, L.A. Care’s director of safety net programs and partnerships. She noted that many of the kids have parents who may not be able to take them to eye-care appointments due to work conflicts.
Vision To Care targeted schools that had at least 65 percent of their students qualifying for free or reduced-price lunches based on their household income. Nearly three-quarters of the exams and glasses provided were to kids enrolled in Medi-Cal. Vision To Learn was paid a flat fee from L.A. Care or Health net of $88, which covered just under 90 percent of its costs, Carroll said. The remainder could be made up with private donations to the organization, he added.
Of the kids who received eyeglasses through the pilot, 66 percent did not previously wear glasses. Of those who already wore corrective lenses, nearly a quarter had prescriptions that were out-of-date.
Data from the state Department of Health Care Services, which operates the Medi-Cal program, show that a large proportion of enrollees are not using their vision benefits. In the 2011-12 fiscal year, 23 out of every 100 school-age children with Medi-Cal vision benefits used them. That dropped to 19 per 100 by the 2015-16 fiscal year.
In L.A. County, the rate that year was slightly better—21 per 100. State officials attributed the higher-than-average access rate in part to the pilot program, although L.A. County’s utilization was also significantly higher than the statewide rate in prior years.
The number of Medi-Cal enrollees grew dramatically beginning in 2014 after eligibility was expanded under the Affordable Care Act, meaning there may have been more children enrolled in Medi-Cal whose parents or guardians were still trying to discern what benefits were available to them. However, a DHCS spokesperson was unable to provide reasons for the decline in utilization.
Whether mobile vans providing vision services to low-income kids in California becomes routine remains to be seen. According to Carroll, VSP Global, the Rancho Cordova-based firm that provides vision services to Medi-Cal enrollees in L.A. County and many other parts of California, will not admit into its network optometrists or other providers who do not work out of a bricks-and-mortar location. A VSP spokesperson noted that state regulations limit mobile clinics receiving reimbursement to those operated by optometric schools.
Klurfeld noted that new regulations requiring the health plan to provide transportation to all medical appointments—including for eye care—took effect earlier this year, which may bump up utilization.
In the meantime, Carroll said the state legislature appropriated another $1 million to “tide over” Vision To Learn while it mulls its options for expanding the pilot. Vision To Learn has also entered into a partnership with the L.A. Unified School District to provide eye exams to its students. It provided more than 13,000 exams and more than 10,000 eyeglasses to students in the district under the pilot.
“If all goes well, in the next school year after this one, the program will be in place permanently,” Carroll said.