Medi-Cal Reimbursement Rates
1/25/2024 – Governor’s proposed state budget includes Medi-Cal reimbursement increase for optometry
The governor’s proposed budget released in January would increase Medi-Cal rates for optometry services to 100 percent of Medicare starting in 2025. The proposal would require Medi-Cal managed care plans to pay no less than the increased rates to their network providers.
If included in the final budget agreement, the most common eye exam codes will be increased by three to four times the current reimbursement rate. This will go a long way toward improving access to care, if approved.
Read the full proposal here.
This is just a proposal, not a done deal. Nevertheless, this has a real chance of passing this year. It’s up to you to convince lawmakers to make this proposal a reality.
You can help in two ways.
1) Post the sample social media posts from this social media toolkit.
2) Register to attend COA’s Legislative Day this year on Monday, February 26 in Sacramento. Lawmakers need to hear how increasing rates will increase access to eye care and facilitate early diagnosis of systemic conditions.
- COA’s top advocacy priority is to double Medi-Cal reimbursement rates in California. Medi-Cal is the one entity where we are allowed to directly advocate for higher reimbursement rates because it is a state-run program. Anti-trust laws prohibit COA and AOA from negotiating higher reimbursements from health plans. However, COA and AOA have had direct dialogue with plan CEOs about the problems and cost pressures that optometrists are facing. We have been actively promoting the fair valuation of optometric services. In addition to concerns about low reimbursement, we are also hearing concerns about vision plan policies that are concerning to our members. AOA has been advocating for legislation at the federal level that would allow optometrists to use the lab of their choice and prevent vision plans from requiring doctors to offer discounts on non-covered services. AOA is building alliances with doctor and patient organizations to help advocate for this change. Also, AOA is taking direct action to resolve insurance related complaints. AOA’s daily email “First Look” publishes the different ways AOA is working to address insurance and vision plan payment issues for its members. They have had some great successes in navigating the complaint process and getting optometrists paid.
- Optometrists can individually attempt to negotiate a higher reimbursement rate with any health plan. Contact provider relations with your request. Be sure to include any information that might help your case, including languages spoken, number of other providers in the area, special services provided, or patient populations treated. While optometrists don’t have to pay their staff the new $25/per hour minimum wage, the market pressure created by the new law will have will make it hard to find anyone willing to work for less. Insurance companies need to hear from optometrists directly about the financial problems you face. The other thing you can do is to contact your legislator about low Medi-Cal rates. The Legislature has the ability to increase those rates next year and we think it will have a ripple effect across the entire health care system. Here is a link to our automated message writing system. If you want to do more, reach out to your lawmaker and ask for a meeting. Let them know about the problems you are facing and the need to increase reimbursements in the Medi-Cal program. COA can provide taking points if you need them. Last year, we had some key lawmakers become strong advocates for increasing Medi-Cal rates after local optometrists met with their lawmakers directly about the problems they face as small business owners in their districts. Together, we can make a difference!
- Last year, COA fought for increased reimbursement rates for optometry services during a $25 billion budget shortfall. Last year’s budget deal adopted a new funding stream and the Department of Health Care Services will make recommendations in 2024 as to which providers will get increased rates. COA has been meeting with the department to make sure that optometry rates are considered for an increase next year. COA lobbyists provided data showing the need to increase optometry rates. Administration officials asked if any optometrists have attempted to negotiate higher reimbursement rates. They argued that managed care organizations had the authority to increase rates on an individual basis. If you have tried to negotiate for a higher reimbursement rate with a Medi-Cal managed care plan, please contact Kristine Shultz at email@example.com or (916) 752-1671. Your experience can help us explain to the department why an across-the-board rate increase is necessary.
- COA’s budget ask to increase reimbursement rates was heard in the Senate Budget Subcommittee on Health. COA is requesting that Medi-Cal reimbursement rates be doubled to keep up with inflation. June 15 is the deadline for lawmakers to vote on a state budget.