Peer-reviewed article
Access to pediatric eye care among Medicaid-insured children in North Carolina.
Cheung NL, Liu EJ, Freedman SF ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether children covered by Medicaid in North Carolina can access eye care services. Researchers surveyed 246 eye care practices and found that fewer than half serve young children aged 0-5 years, and those who do accept Medicaid patients face much longer wait times than private patients. Low insurance reimbursement rates, administrative burden, and company policies prevent many practices from accepting Medicaid at all.
Key points
- Only 44% of surveyed eye care practices provide routine eye care to children aged 0-5 years, compared with 84% for children aged 6-17 years
- Among Medicaid-participating practices, 56% serve children aged 0-5 years while 100% serve children aged 6-17 years
- Medicaid patients waited a median of 46 days for appointments compared with 14 days for privately insured patients
- Low reimbursement (43%), administrative burden (30%), and corporate policies (27%) were the main barriers cited by practices not accepting Medicaid
- 20% of Medicaid-participating practices did not provide Medicaid-covered spectacles
Limitations
This study is based on telephone surveys of front-desk staff and may not capture actual clinical practice patterns or the full range of barriers families experience. The study does not measure whether children actually received eye care or the health outcomes of access disparities.
Abstract
Background Individuals with Medicaid/Children's Health Insurance Program (CHIP) in North Carolina face significant barriers to accessing eye care, including limited provider participation and long wait times. The purpose of this study was to investigate the availability of pediatric eye care services and participation in Medicaid among ophthalmology (MD) and optometry (OD) practices in North Carolina. Methods A cross-sectional telephone survey was conducted with 368 randomly sampled practices stratified by county population density quartiles. The sampled practices represent 24% of all ophthalmology and optometry practices statewide. Front-desk staff were queried about pediatric service availability, Medicaid participation, and appointment wait times, for a hypothetical routine eye examination. Data were analyzed using χ2 tests and logistic regression. Results A total of 368 practices were surveyed, of which 246 completed the survey. Combined MD/OD practices were more likely than MD-only or OD-only practices to accept Medicaid (P < 0.001). Larger practices (>5 providers) were more likely to accept Medicaid (86% vs 64% [P < 0.01]). Of the practices participating in the survey, 44% provided routine eye care to children 0-5 years of age, compared with 84% providing care to children 6-17 years of age (P < 0.0001). Among Medicaid-participating practices, 56% provided routine eye care for children aged 0-5 years, whereas 100% provided routine eye care to children aged 6-17 (P < 0.0001). Medicaid patients faced median appointment wait times of 46 days, compared with 14 days for privately insured patients at non-Medicaid practices (P < 0.001). Of Medicaid-participating practices, 20% did not provide Medicaid-covered spectacles. Low reimbursement (43%), administrative burden (30%), and corporate policies (27%) were cited as key barriers by practices not accepting Medicaid. Conclusions Access barriers for Medicaid-insured children in North Carolina are primarily driven by practice-level participation policies, administrative complexity, and reimbursement concerns, with younger children facing disproportionate vulnerability.