Medicaid, the program that subsidizes health care for low-income Americans, operates under federal guidelines, but each state sets specific criteria for who is eligible and what kinds of things Medicaid will cover. For that reason, Medicaid coverage for eyeglasses will vary by state. In some, the program pays for new glasses; in others, it requires recipients to pay part of the cost; and in some, it offers no coverage at all.
No Coverage
According to the Kaiser Family Foundation seven states offer no coverage at all for eyeglasses or other corrective lenses. Those states are Kentucky, Louisiana, Maryland, Nevada, Oklahoma, Vermont and Virginia. The remaining 43 states and the District of Columbia offer varying levels of coverage.
Special Cases Only
About a dozen states cover eyeglasses only under special circumstances. In Arizona, Colorado, Delaware, South Carolina, Tennessee, West Virginia and Wyoming, Medicaid covers glasses or lenses only after certain surgeries, such as for cataracts. Connecticut, Florida and Pennsylvania allow them only for specific medical conditions, not just poor eyesight. Georgia and Utah cover glasses for children but limit coverage for adults. Georgia covers them for adults in nursing facilities, and Utah covers only pregnant women.
Frequency
In the rest of the states, Medicaid covers eyeglasses. In many cases, a person must need a minimum level of eyesight correction before Medicaid will pay. The programs usually limit how often a person can get new glasses. The most common limit is one pair every two years, but other time frames include one year (Alaska, Arkansas, Illinois, New Hampshire), 15 months (South Dakota), three years (North Dakota), four years (Idaho, Kansas) and five years (Mississippi). New Jersey and Ohio pay for one pair of glasses every two years until age 59; after that, they pay for a pair once a year. And Maine's Medicaid program will pay for only one pair of glasses in a recipient's lifetime.
Copayments
According to the Kaiser Family Foundation, 14 states and the District of Columbia require a copayment for Medicaid glasses coverage. These copays can be as little as 50 cents and as high as $30, though most are in the $2 to $3 range. States that require a copay are Arkansas, Iowa, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, North Carolina, Ohio, Pennsylvania, South Dakota and Wisconsin.
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