09/18/11 — Medicaid patients face cuts in exams

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Medicaid patients face cuts in exams

By Phyllis Moore
Published in News on September 18, 2011 1:50 AM

Medicaid patients are being encouraged to enroll with a primary card provider to offset state cuts in coverage for eye exams and glasses, as well as some dental treatments, when the cuts become effective in October.

The situation concerns health care providers because they believe many patients will delay medical visits and could wind up with worse health problems.

Reports surfaced earlier this month that the state is cutting eye care for adult Medicaid patients, as part of a $354 million reduction to help the state deal with its budget problems.

According to the state's Department of Health and Human Services, the financial woes are just beginning.

"There will be a lot more changes in the Medicaid program over the next two years," said Brad Deen, a spokesman for the department.

"What has happened is that, of course, they're going to lose any adults 21 and older, they're going to lose their benefits for exams," said Renee Smith, practice administrator with Mitchell Eye Center. "They're not going to be covering them at all. That's kind of big for all of them (patients).

"Our practice alone, we probably see 20 to 30 percent that are Medicaid."

The program only allows for adult Medicaid patients to have their eyes examined every other year.

"First off, my concern would be for the patients," she said. "With optometry, a lot of the diseases of the eye are detected in the early eye exam. You may have these medical diseases that will go undetected, especially like those with diabetic retinopathy, things that cause blindness."

"We're not cutting out all eye exams," Deen said. "If someone has an underlying problem, obviously we'll be testing that person's eyes and vision. It will be eliminating routine exams. That's one of the reasons we strongly encourage people who are covered by Medicaid to sign up for a medical home."

He went on to say that for years the state has been encouraging Medicaid patients to sign up with a primary care provider. The move, he said, makes it easier to obtain a referral for a specialist should any problems arise.

"We currently have about 80 percent of Medicaid enrollees signed up with medical care providers," he said. "Medicaid, DHHS, as well as Community Care of N.C., an independent non-profit ... what's been happening for a decade is that Medicaid has been working with our CCNC to get people into a medical home."

But when times are tight, vision care is one of the first things affected, Ms. Smith said.

"The fact is, the whole purpose that they have Medicaid is that they can't afford it and if they are actually a Medicaid recipient and qualified, you know they can't afford eye care," she said. "People start cutting out vision, dental. We do see that."

At age 65, she said, Medicaid will take care of any related health concerns, like diabetes, but that doesn't help those who are undiagnosed.

"You're talking about the people between 21 and 64 that are affected by this. A lot of problems start arising after 40, a lot of people would be affected," she said. "I don't think they have thought this through, especially for those with contributing medical conditions."

With less than a month before the mandate goes into effect, Ms. Smith said some patients are making a last-ditch effort to schedule one final appointment. That only works, though, if their last exam was done at the prescribed time.

"The problem is, if they had their eyes examined last year, they have to go a full 365 days before the next one," she said. "So there's no getting in and trying to get in before the date, because they're not able to do that."