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

New requirements for Medicaid in 2027 may impact your eligibility

Medicaid requirements are changing in 2027 with the addition of Medicaid work or community engagement requirements.

Starting January 1, 2027,  most adults with Medicaid will need to show they are doing one or a more of the following activities in order to keep their Medicaid coverage:

  • Working
  • Doing community service
  • Completing job training, or
  • Going to school

These are called “community engagement requirements” or may also be called Medicaid “work requirements.” The requirements generally apply to certain adults ages 19–64 who are not pregnant and those who are not entitled to or enrolled in Medicare.

These requirements do not apply to everyone. Some people are excluded, including certain people who are blind, have disabilities, or have serious health conditions.

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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.

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).

Where can I find out more?

Common questions about vision coverage

Patient and Financial Assistance Programs

External Resource

Eye Care Access and Advocacy

Issues that can impact eye care

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More about how eye care is covered by each type of insurance.

a working-age woman wearing glasses
a working-age woman wearing glasses
Private/Employer Coverage
Is vision care part of your private insurance or employer health benefits?...
Is vision care part of your private insurance or employer health benefits?...
Find Out More
a middle-aged man wearing glasses.
a middle-aged man wearing glasses.
Health Insurance Marketplace (ACA Plans)
What are the common vision benefits available under coverage from an ACA Exchange plan?...
What are the common vision benefits available under coverage from an ACA Exchange plan?...
Find Out More
an active senior couple wearing glasses
an active senior couple wearing glasses
Medicare (65+)
For individuals who are 65 and older, Medicare offers a number of important benefits for eye and vision care...
For individuals who are 65 and older, Medicare offers a number of important benefits for eye and vision care...
Find Out More

I do not have insurance coverage. How do I access eye care?