Opinion: I was on Medi-Cal as a Child. As an Optometrist, I’m Struggling to Provide Care for These Children

Photo by Vasyl Dolmatov/iStock

When I came to this country as an immigrant child, Medi-Cal, California’s health care program
for people with low incomes, was a lifeline for my family. I credit this safety net for helping me
attend UC Davis and become an optometrist. My husband, who was raised by a single mom
and received Medi-Cal, succeeded in his California dream as well. Today we own four
optometry practices in the Sacramento area, and we are committed to giving back by serving
Medi-Cal patients.

But it’s getting harder to keep the doors open to Medi-Cal patients. Each year, the gap between
the cost of providing care and what the state covers grows wider. While Gov. Gavin Newsom
has proposed improving Medi-Cal access by paying medical doctors, OB-GYNs and hospitals
more this year, eye care is left out of his proposal. That’s a mistake that doesn’t just hurt
optometrists — it hurts our patients who need clear vision to learn in the classroom, drive safely
or use a computer.

The amount California pays optometrists for treating Medi-Cal patients hasn’t increased in over
20 years. Right now, the state reimburses my practice just $47 for a new patient eye exam and
testing to determine an eyeglass prescription, but the cost to my business is four times that
amount. Everyday expenses like rent and the price of equipment have soared. Our dedication to
Medi-Cal patients unfortunately doesn’t pay our staff’s salaries or keep the lights on; accepting
Medi-Cal patients has become a math problem that just doesn’t pencil out.

Compared to similar programs in other states, California pays the third-lowest rate in the nation to optometrists, even though we have among the highest costs of doing business. These grim statistics are reflected in the dwindling number of optometrists currently accepting Medi-Cal. More than 1 in 10 optometrists reported leaving the Medi-Cal program in the last two years, according to a recent survey of California Optometric Association members. Patients report trouble finding a provider who will take them. Even if they do, they must often travel long distances and could likely face long wait times. For instance, in some areas it can take months to get an appointment to treat a scratch on your eye.

It’s important to remember that eye care is health care. Optometrists aren’t just here to help you
pick out a nice pair of glasses, although that’s also important. We catch illnesses and conditions
that might otherwise go undetected until it’s too late. High blood pressure, heart disease and
diabetes are among the serious conditions often first detected with an eye exam.

Treating children is also crucial. We can often correct vision problems with timely diagnosis and treatment. But far too often kids are falling through the cracks. Studies have shown that 80 percent of classroom learning is visual. If kids can’t see, they can’t succeed. 

A modest increase in Medi-Cal payments would help alleviate so many of these problems. More
optometrists could afford to take on Medi-Cal patients, and practices could feel more secure
about continuing to treat them. Most importantly, people on Medi-Cal would have more access
to the quality health care they deserve.

Over 13 million people receive Medi-Cal, including half of the state’s children. And the rolls will only grow as the state continues to expand who’s eligible for the program. Expanded access is excellent in theory, but it means little practically if providers can’t afford to accept Medi-Cal. We need both expanded access and increased reimbursement rates for Medi-Cal patients to truly thrive.

I was the first woman in my family to earn a college degree. My husband was the first in his
family to graduate from college. We’ve kept accepting Medi-Cal, even at a loss, because we
want the kids in our clinic today to have the same chances we did.

But we can’t do this forever and keep our doors open. Newsom and legislators will finalize a
state budget in the coming weeks — and it must include an investment in the healthy eyes of
Medi-Cal patients.

Dr. Heidi Pham-Murphy is the president and owner of Visions Optometry in

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