H.R. 1219: What it is and why we need it!

June 11, 2011

If you don’t know who you are, you can’t possible get to where you’re going. 

For the health and well-being of our patients and future success of our practices, it’s critical that we define, once and for all, who we are and where we are at on the roadmap when it comes to Medicaid.

H.R. 1219, the Optometric Equity in Medicaid Act, will allow us to do just that.

Introduced by AOA supporters Rep. Ralph Hall (R-Texas) and Rep. Jan Schakowsky (D-Ill.), H.R. 1219 seeks to avert a potential crisis in access to primary eye care for Medicaid patients by amending the federal Medicaid statute to fully recognize optometrists to provide “medical and other health services to the extent those services may be performed under state law.”

Why is this important?

Well, as you know, for many years, we’ve had some flawed language in Medicaid. What you may not know is the current Medicaid program covers more than 51 million Americans, and under the Affordable Care Act (ACA), 20 million more Americans will get their health care coverage through this program.

With this increase of covered lives in Medicaid comes an increase in state costs associated with the program.  

According to the federal government, overall Medicaid expenditures increased by nearly 7 percent in fiscal year 2010, and the states’ share of Medicaid spending is projected to increase nationally by $25 billion in 2011.

In addition, states that wish to receive additional money from the federal government to cover the 20 million more Americans added to Medicaid must continue to offer Medicaid coverage at their 2010 levels. 

Called Maintenance of Effort (MOE), if states continue their coverage at 2010 levels, they will be eligible for a 100 percent Medicaid match from the federal government.

This match would decrease to 90 percent by 2020.

Needless to say, with the budget stresses that the states are facing, Medicaid will continue to face additional scrutiny and pressure to rein in expenditures.

Now, due to two forces at hand – the windfall of 20 million Americans who will be eligible for Medicaid under health care reform in 2014 and economic downturns forcing states to slash already tight budgets – some states have decided to eliminate adult eye care.

They can do this because the language was not specifically defined to include optometry as necessary primary care.

Because of this, the services optometrists provide continue to be considered optional, and thus, vulnerable to state cuts.

This very thing happened most recently in California, and we were lucky to have optometry services reinstated less than a year after they eliminated them using a 1972 federal law called the Coshatt amendment.

Originally added to the federal Medicaid statue through the activism of Dr. Elbert A. “Bert” Coshatt, an optometrist from Alabama, the Coshatt amendment requires state Medicaid plans to include optometrists as Medicaid providers if:

  •  the state previously covered optometrists for Medicaid services (but not necessarily materials); and
  •  if the state Medicaid plan continues to cover physicians for services that optometrists are legally authorized to perform.

The state of Virginia nearly did the same thing as California, but we successfully convinced them not to eliminate adult optometric services in that state’s Medicaid program by using the Coshatt amendment, even though the state was facing a budget shortfall in excess of $4 billion.

But the Coshatt amendment, while useful, should be seen as a temporary fix to a serious issue that we face.

So I strongly urge affiliates to fight alongside the AOA to make H.R. 1219 a priority. 

We want states to prepare in advance so that optometry will be in the strongest possible position to ensure that ODs and their patients will not be unfairly targeted during the next round of state-level Medicaid cuts to be proposed.

We’ve got a big battle ahead of us now to work in Washington to clarify this Medicaid issue, which we’ll need to do by the year 2014 when the expanded Medicaid population hits the health reform time table.

I know I’ve said it before, but I can’t emphasize enough the fact that we’ve got to all work together in the coming months and years as legislators and policymakers increasingly make decisions about the direction of health reform implementation – both at the national and state levels.

Because at the end of the day, it’s NOT just about what you know, but also who you know. 

Because at the end of the day, it’s about ACCESS! ACCESS! ACCESS!

Joe E. Ellis, O.D.
AOA president

One comment

  1. […] did we fight for? – Click each bill to find out more about it – HR 1219 – HR […]

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