...continued from Medicare and Medicaid Vision Benefits, page 2

Medicaid Coverage

Medicaid is a form of health insurance that is funded by the federal government and managed by the individual states. Medicaid pays for many of the health needs of U.S. citizens or permanent residents who have lived in the U.S a designated length of time and who, among other requirements, have high medical bills, low incomes, and very few personal resources.

Income requirements and medical coverage vary from state to state. Income requirements generally are based on the federal poverty line. In 2006, the federal poverty line for an individual was $9,800 annual income in the 48 contiguous states, $11,270 in Hawaii, and $12,500 in Alaska. For a married couple, the federal poverty line was $13,200, $15,180, and $16,500 respectively.

People eligible for Medicaid are entitled to at least the following health services that also will cover certain medical conditions such as eye diseases and some vision benefits:

• In-hospital stays, except in mental illness institutions
• Out-patient hospital care in certain health clinics
• Laboratory services
• Early and periodic screening, diagnosis, and treatment (EPSDT) for children under 21
• Certain home health services
• Care during and after pregnancy

Medicaid pays directly to health care providers and not to Medicaid members. Members may be asked to pay a portion of the medical bill (co-payment) at the time a medical service is received.

What Vision Benefits Are Available Under Medicaid?

The following vision benefits are available for children under 21 under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program of Medicaid:

• Eye exams
• Eyeglass frames
• Lenses

Each state individually determines how frequently these services may be accessed.

Many states also offer similar vision services for adults aged 21 and older. Some states also provide for glaucoma screening to help detect this common eye disease that can damage the eye's optic nerve and cause permanent vision loss.

Because cataracts clouding the eye's natural lens are a medical condition, Medicaid will cover a portion of the cost of cataract surgery, doctor care and the hospital stay.

To learn more about your state's eligibility requirements, call your state's Medicaid agency.

[Page updated October 2006]