Medi Cal Vision Benefits

VISION

Governor Newsum’s 2019 budget includes money to restore — at least for the next two years — a variety of services that were deemed nonessential during the recession: optical services, podiatry, help for incontinence issues, audiology and speech therapy. Those services will be available starting Jan. 1.  LA Times 6.28.2019LA Times 6.13.2019

The following vision services are covered for Medi-Cal Members:

 Medically Necessary eye examinations for Diagnosis, treatment or prevention of eye disease or detection of ophthalmologic complications of medical disease.

 Routine eye examination (refraction) every two years. Members may self-refer to obtain routine vision services from a participating optical Provider. Members may contact Member Services at 1-800-675-6110 to obtain a directory of participating optometrists and ophthalmologists.

 Eye examination every year by an ophthalmologist or optometrist for Members with diabetes or other Chronic medical problems affecting the eye

 Medical eye exams by an ophthalmologist or optometrist for Acute or Urgent Care

 Contact lenses when Medically Necessary are covered for Eligible Medi-Cal Members 20 and under or Members residing in Skilled Nursing Facilities (SNFs). Adults 21 and over are covered for bandage contacts only when Medically Necessary; other ophthalmological materials are not covered.

Optical lenses and frames (every two years) for Members under age 21, pregnant women if your doctor says not having them will be harmful to your baby or pregnancy, and people living in a nursing home. Optical lenses are made by the California Prison Industry Authority (CALPIA) optical laboratories unless you are being seen by an Authorized Mobile Vision Service provider (LA County only); however, our plan or the delegated participating Medical Group, as applicable, will arrange for this service. Optical lenses and frames for Members age 21 and over are not a covered benefit   Health Net Evidence of Coverage Page 30

 

Links & Resources

dhcs.ca.gov/VisionBenefits  

Check for the specific coverage of each Medi Cal participating HMO

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