Appeals court decision expands OD opportunities

In a win for optometrists, the 9th U.S. Circuit Court of Appeals ruled July 5 that mandatory services in rural clinics and federally qualified health centers (FQHC) must be covered by the state Medicaid program. The decision paves the way for more OD participation at these facilities.

Ruling presents an enhanced opportunity for optometrists.

The clinics and health centers had sued the state of California for eliminating coverage of so-called "optional services" in Medicaid. These included adult optometric services, podiatric services, chiropractic services, and adult dental services. 

Previously, the AOA and the California Optometric Association worked together to successfully reverse the state's attempt to eliminate adult medical eye care provided by optometrists in Medicaid. However, the clinics and health centers pursued the case to ensure coverage for the eliminated services at their sites.

The appeals court's decision does not mean that optometrists in California or other states can be considered "physicians in the Medicaid program." The Medicaid law requires coverage of physician services provided by a medical doctor or doctor of osteopathic medicine, and, if AOA-backed legislation (member login required) advances in Congress, a doctor of optometry. Moreover, federal law prevents states from eliminating coverage of medical eye care already provided by optometrists.

The time for ODs and affiliates to act is now

The AOA Health Center Committee has analyzed the federal appeals court ruling and believes it presents an enhanced opportunity for optometrists. Those who want to serve patients in rural clinics and FQHCs will be better able to do so because medical eye care for adults and children will now be covered in Medicaid, unless the U.S. Supreme Court is persuaded to intervene and overturn the decision. 

The decision is one of many factors that make now a good time for optometrists and affiliates to reach out to these facilities. For example, only 134 full-time equivalent optometrists at FQHCs nationwide currently provide optometric care. In addition, coverage is set to expand under the new health care law.

AOA offers resources, including key questions to ask and supporting materials, to help state affiliates and practitioners approach local facilities about adding optometry to their scope of services.

August 7, 2013

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