Like so many other states, Virginia faces a budget shortfall this year, resulting in the legislature eliminating all “optional” Medicaid services. According to the Virginia Optometric Association’s Executive Director and Chief Lobbyist, Bruce Keeney, “cutting out services by optometrists for adult Medicaid patients was not an attack on optometry but simply a result of Virginia facing a $4.1 billion shortfall in a political environment where tax increases were not on the table.”
During the legislative process, the VOA was able to include a provision in the Budget Bill that adult Medicaid services by optometrists would be restored if Congress approved additional funds to assist States in meeting their spiraling Medicaid costs. Unfortunately, Congress failed to approve those funds before the cuts went into effect on July 1.
Timing is everything. Literally 2 weeks before the cuts were to take place, the AOA staff from the State Government Relations Center and the Washington Office provided the citation of a 1972 federal law which proved to be the turning point. The VOA quickly had legal counsel review the federal statute, confirming that an amendment to the Social Security Act required State Medicaid plans include optometrists as Medicaid providers if (1) the State had covered optometrists for Medicaid services previously and (2) the State Medicaid plan continued to cover physicians for services optometrist are legally authorized to perform.
In hope of avoiding the need to file in Federal Court, the VOA provided their legal counsel’s opinion to the Governor’s office just one week before the cuts were to take place. With a good relationship with their Governor, the VOA agreed to postpone legal action so as to provide the Governor’s office time to thoroughly research the issue. However, the elimination of services proceeded, effective July 1.
As expected, the elimination of these services caused problems. Virginia optometrists, especially with rural and inner city practices, were forced to refer patients to hospital emergency rooms for care. To compound problems, of the few Virginia ophthalmologists accepting Medicaid patients, many refused to accept new Medicaid patients. Frustration in this less fortunate patient population have no access to care resulted in extensive media coverage and calls by legislators to the Governor, questioning when the issue would be resolved. Attention to this issue apparently resulted in calls to the Governor’s office by other health professions (whose “optional” services were also eliminated in the Budget Bill) requesting their services be reinstated if such was to take place for optometry. Noting this would have exasperated the fiscal impact, the VOA noted the federal law being cited was limited to optometry.
About six weeks after the elimination of these much needed services went into effect, the VOA received official word from the Cabinet Secretary’s office that services for adult Medicaid patients by optometrists would be restored and reinstated, retroactive to July 1. In Virginia, Medicaid covers and reimburses optometrists for both routine eye exams and medical eye care.
Mr. Keeney noted that for Virginia optometry, the priority was to ensure the adult Medicaid population in Virginia had access to much needed eye and vision care services. “While patient care remained our top concern, we do not tolerate any type of health insurance plan discriminating against our doctors. We also were confident of the outcome, knowing our Governor appreciates the services provided by optometrists and his commitment to the delivery of quality health care services to all Virginians.”
Dr. George Brown, President of the Virginia Optometric Association, advised their members of “the much needed and valuable assistance the AOA provided as we addressed this most serious problem. It provided just one more example of the value of AOA membership.” With federal matching dollars, reinstating optometric coverage for adult Medicaid patients may $850,000 to $1 million in claims paid to Virginia optometrists in the State’s next fiscal year.