Public Health Insurance Programs: Medicaid and the Children’s Health Insurance Program

Medicaid

Medicaid vision coverage for children under 21, and children in foster care until age 26, is federally mandated, while coverage for adults is determined by each state.

Medicine for eyes and vision

Coverage for prescription eye medications is generally included for both children and adults, though specifics can vary.

Medicaid drug coverage may have copays, and some brand-name or special medications may require prior authorization.

Coverage for children (under 21 years of age)

Federal law requires coverage for screenings, comprehensive exams, and eyeglasses.

Coverage for adults

Adult vision coverage is an optional benefit for states. Some states provide comprehensive coverage, while others offer only limited or medically necessary eye care.

Medicaid and access challenges

Some studies suggest that individuals with Medicaid may face more difficulty scheduling eye care appointments compared to those with private insurance.

Cosmetic or elective eye care

Cosmetic or elective vision services such as Lasik or Botox typically are not covered by Medicaid.

Children’s Health Insurance Program (CHIP)

CHIP provides low-cost health coverage to children and pregnant women in families that earn too much money to qualify for Medicaid. Each state offers CHIP coverage and works closely with its state Medicaid program. There may be differences in program qualifications and coverage by state.

Typical CHIP vision benefits include

Eye exams: Routine and medically necessary comprehensive eye exams.
Eyeglasses (frames and lenses): Coverage for prescription glasses and replacements as medically necessary.
Vision screenings: Regular vision screenings are covered as part of well-child visits.
Specialty care: If an eye condition is detected, CHIP may cover additional exams or treatment by an ophthalmologist or optometrist.
Contact lenses: Covered if medically necessary (for example, for certain eye conditions like keratoconus).