Eye Doctors That Accept Medicaid: How to Find One Near You

It may be easier than you think to locate a doctor who takes Medicaid, but coverage and provider networks differ from state to state. All children younger than 21 years must get comprehensive vision care in Medicaid through EPSDT (Early and Periodic Screening, Diagnostic, and Treatment), and adults can get comprehensive vision care under Medicaid if they choose. Most states provide at least a basic eye exam for adults; approximately 26 states provide eyeglasses. Nearly all states include surgical procedures such as cataract removal in their definition of medically necessary.

This guide will help you to learn how to locate a medicaid eye doctor near you, what medicaid vision coverage provides state by state and how medicaid eye care is different for adults vs kids. Medicaid.gov, CMS and state Medicaid agencies provide information. 

Does Medicaid cover eye exams?

Does Medicaid cover eye exams? Yes for children, almost universally. Yes for adults, in most states, with some variation. Federal EPSDT requirements mandate comprehensive vision services for Medicaid children under 21 in every state. Adult coverage is more variable and depends on state-specific Medicaid policy.

For adults, eye exam coverage typically falls into one of three categories:

• Routine + medical exams covered: About 30 states cover both annual routine eye exams (refractive error testing for glasses) and medical eye exams (for conditions like glaucoma, diabetic eye disease, macular degeneration)

• Medical exams only: Some states cover eye exams only when medically necessary for a specific eye condition, not routine vision testing

• Limited coverage: A few states cover eye exams only for specific groups (pregnant adults, people with diabetes, dual-eligible beneficiaries)

For people with diabetes, retinal screenings are typically covered in every state because of their importance in preventing vision loss from diabetic retinopathy. The American Optometric Association and CMS guidance treat diabetic eye exams as medically necessary services.

Medicaid eye doctor: what to look for

A medicaid eye doctor can be either an optometrist (OD) or ophthalmologist (MD/DO). Both can be found through Medicaid networks.

• Optometrists (ODs): Provide routine eye exams, prescribe glasses and contacts, diagnose and manage common eye conditions. Most participate in Medicaid for routine and medical exams.

• Ophthalmologists (MD/DO): Provide comprehensive eye care including surgery. Required for cataract surgery, retinal procedures, and complex eye conditions.

For most routine vision needs, an optometrist participating in your state Medicaid program is the right starting point. For surgical or complex care, you'll be referred to an ophthalmologist.

Vision care providers contracted with Medicaid managed care organizations (MCOs) often differ from those contracted directly with state Medicaid. If you're enrolled in a Medicaid MCO, your provider directory will be specific to that plan, not the state's full Medicaid network.

Medicaid vision coverage: what's covered for adults

Medicaid vision coverage for adults typically includes some combination of:

Eyeglasses coverage is particularly variable. Some states provide one pair of glasses every 1 to 2 years with reasonable frame allowances. Others provide glasses only every 3 to 5 years or only when prescription change is significant. Children, again, have more comprehensive coverage in every state.

Medicaid eye care for children

Medicaid eye care for children under 21 is comprehensive in every state under federal EPSDT requirements. Coverage typically includes:

• Annual or biennial eye exams

• Eyeglasses and frames (multiple pairs per year if medically necessary)

• Contact lenses when medically necessary

• Vision therapy for some conditions

• Treatment for eye conditions like amblyopia (lazy eye), strabismus, refractive errors

• Surgery for medical conditions (corrective surgery for strabismus, congenital cataracts, etc.)

Federal law requires Medicaid programs to schedule annual or biennial eye screenings for all enrolled children, and to follow up with treatment when problems are identified. About 1 in 4 U.S. children receive their vision care through Medicaid or CHIP, per CMS data.

How to find an optometrist that accepts Medicaid

Find optometrist medicaid options through these channels:

1. Your state Medicaid agency's provider directory. Every state Medicaid program maintains an online searchable directory of participating providers. Search "[your state] Medicaid eye doctor" or visit your state Medicaid agency website.

2. Your Medicaid managed care plan's directory. If you're enrolled in a Medicaid MCO (Medicaid managed care plan, like UnitedHealthcare Community Plan, Anthem Medicaid, etc.), your specific plan's provider directory is what matters. Member services can mail you a directory or guide you online.

3. Federally Qualified Health Centers (FQHCs) and community health centers. Many provide vision services and accept Medicaid. Find centers through HRSA's directory.

4. Vision-specific Medicaid networks. Some states contract with specialty vision networks (like March Vision Care, Davis Vision Medicaid, Superior Vision Medicaid) that handle vision care for Medicaid enrollees. Check whether your state uses one and find providers through their directory.

5. Schools of optometry. Accredited schools of optometry (like the SUNY College of Optometry, Pacific University, etc.) accept Medicaid for supervised student-provided eye exams at reduced rates. Wait times can be longer.

Call ahead before scheduling. Some optometrist practices accept Medicaid for some services but not others, or limit Medicaid patient acceptance based on capacity.

Medicaid eye doctor specifically for kids

For children specifically, finding pediatric optometrists or ophthalmologists who accept Medicaid is straightforward. Federal EPSDT rules ensure broad participation, and most pediatric vision providers participate in their state Medicaid program.

Resources for finding pediatric Medicaid vision care:

• Insure Kids Now for state-by-state Medicaid and CHIP provider locators

• Pediatric optometry programs at colleges of optometry

• Children's hospitals affiliated with academic medical centers, which often have pediatric ophthalmology departments accepting Medicaid

Vision screening at school is sometimes the first place children's vision issues are identified. School nurses can connect families to Medicaid-participating providers for follow-up evaluation.