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Frequently Asked Questions - Optometry/Optical Benefits (Eye Exam and Eye Glasses)

  1. My vision is getting worse. Can I have an eye exam to have it checked after June 30, 2009?
  2. I need eye glasses to read and drive. Can I still get them after June 30, 2009?
  3. My eyeglasses were lost/broken/stolen. Can I have them replaced after June 30, 2009?
  4. My eyeglasses were lost/broken/stolen. Can I have them replaced after I reach 21 years of age?
  5. I am visually impaired. Can I get low vision services and aids through Medi-Cal to help me see after June 30, 2009?
  6. I have an eye disease that can only be corrected with contact lenses.  Can I get contact lenses after June 30, 2009?
  7. I have a prosthetic eye.  Can I get it polished or replaced, if necessary, after June 30, 2009?

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1. My vision is getting worse. Can I have an eye exam to have it checked after June 30, 2009?

Answer: Yes, you can obtain an eye examination from a Medi-Cal participating optometrist or ophthalmologist in your area. You can access the following link to find an eye care provider in your area to schedule an appointment: http://www.dhcs.ca.gov/services/Pages/VisionFindADr.aspx

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2. I need eyeglasses to read and drive. Can I still get them after June 30, 2009?

Answer: No.  Starting July 1, 2009, Medi-Cal will no longer pay for eyeglasses.

Only the following persons are eligible for eyeglass coverage after June 30, 2009:

a. Pregnant women; and only if your doctor explains in his/her report that not having eyeglasses will harm your baby.

b. Children and young adults 20 years old or younger who receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) (including ICF-DD Habilitative and ICF-DD Nursing) and Sub Acute Facility.

 

3. My eyeglasses were lost/broken/stolen. Can I have them replaced after June 30 2009?

  Answer: No. Only the following persons are eligible for eyeglass replacement after June 30, 2009:

a. Pregnant women; and only if your doctor explains in his/her report that not having the eyeglasses replaced will harm your baby.

b. Children and young adults 20 years old or younger who receive full scope Medi-Cal. 

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) (including ICF-DD Habilitative and ICF-DD Nursing) and Sub Acute Facility.

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4. My eyeglasses were lost/broken/stolen. Can I have them replaced after I reach 21 years of age?

Answer: No. Only the following persons are eligible for eyeglass replacement. 

a. Pregnant women; and only if your doctor explains in his/her report that not having the eyeglasses replaced will harm your baby.

b. Children and young adults 20 years old or younger who receive full scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) (including ICF-DD Habilitative and ICF-DD Nursing) and Sub Acute Facility. 

 

5. I am visually impaired. Can I get low vision services and aids through Medi-Cal to help me see after June 30, 2009? 

Answer: The low vision examination remains a covered benefit and can be provided by a Medi-Cal participating optometrist or ophthalmologist in your area. Low vision aids, however, are not a covered benefit. Only the following persons are eligible to receive low vision aids after June 30, 2009: 

a. Pregnant women; and only if your doctor explains in his/her report that not having these services will harm your baby. 

b. Children and young adults 20 years old or younger who receive full-scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) (including ICF-DD Habilitative and ICF-DD Nursing) and Sub Acute Facility.

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6. I have an eye disease that can only be corrected with contact lenses.  Can I get contact lenses after June 30, 2009? 

Answer: No. The contact lens evaluation provided by an optometrist or ophthalmologist for medically necessary conditions remains a covered benefit under the Medi-Cal program. However, only the following persons are eligible to receive medically necessary contact lenses after June 30, 2009: 

a. Pregnant women; and only if your doctor explains in his/her report that not having these services will harm your baby. 

b. Children and young adults 20 years old or younger who receive full-scope Medi-Cal.

c. People who live in a licensed nursing home such as a Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF), ICF for the Developmentally Disabled (ICF-DD) (including ICF-DD Habilitative and ICF-DD Nursing) and Sub Acute Facility 

 

7. I have a prosthetic eye.  Can I get it polished or replaced, if necessary, after June 30, 2009?

Answer: Yes.  Prosthetic eye services are not impacted by the Optional Benefits Exclusion.