Marin lags among counties in providing eye care to low-income children
This story originally appeared in the Marin Independent Journal.
By many measures, Marin County is among the healthiest places in California. But when it comes to the eyesight of children, Marin has for years had a more dubious distinction.
Children dependent on Medi-Cal in the county receive eye exams and glasses at a much lower rate than their counterparts in most other counties in the state. In the five most recent years for which state data is available, Marin has ranked near or at the bottom every year.
Last year, in the county’s best showing in recent years, 7.6 percent of residents under 21 years old who were eligible for Medi-Cal got eye exams, compared to a statewide average of nearly 12 percent. Just 4.6 percent of eligible young patients received glasses through Medi-Cal, compared with 9.5 percent statewide.
Representatives from the county and from Partnership HealthPlan, which has administered Medi-Cal here since 2011, say they have been working hard to turn those numbers around.
Dr. Gina Day, though, has a theory about why poor kids here aren’t getting more vision care: She thinks her fellow optometrists don’t want the business.
In part, she says, this is because of poor reimbursement rates and voluminous paperwork associated with the government insurance program. In an area with such a high cost of living, it can feel untenable to accept $40 from the state for an office visit that might otherwise net $130, she says.
And, she said, “there’s a certain stigma about Medi-Cal patients. I don’t want to say ‘racism,’ but there is classism.”
Day — who for nearly 20 years has seen patients at her clinic in Larkspur — is one of the few private optometrists in the county willing to accept children with Medi-Cal. While Partnership HealthPlan offers a list of five, two of those are actually in Sonoma County, and one of the others stopped seeing Medi-Cal patients earlier this spring.
Royce Kakar, the office manager for that clinic, San Anselmo Optometry, said the clinic had tried to do the right thing by accepting children with Medi-Cal, but that they had been so frustrated by miscommunication and bureaucracy that they recently began refusing it. These days, they do free eye exams and glasses for low-income children who call their office.
“It was supposed to be really promising,” he said.
‘COMES DOWN TO COST’
Dr. Susan Mozayani — who has practiced for 12 years at Marin Eye Care in Novato, and who does not accept Medi-Cal clients — said in an email: “Basically, it comes down to cost.”
“The office expenses are very high and we need to be able to justify for our time and paying the bills,” she said.
Access to eye exams and eyeglasses is problematic for low-income children all over the state. According to a report from the Center for Health Policy Research at the University of California, Los Angeles, 95 percent of Californian first-graders who need glasses do not have them.
Schools often identify vision problems. But many optometrists and advocates say parents also fail to prioritize vision care — either because they don’t believe it’s important, or because they don’t have the time off work or transportation to get their kids to the optometrist.
“You can refer until the cows come home, but unless the parent takes the child to the optometrist or physician, the glasses don’t go on the face,” said Katy Waugh, past president of the California School Nurses Organization, who worked in the Cupertino School District in Santa Clara County for 28 years.
Failure to identify and correct children’s vision problems can have dire consequences.
Amblyopia, or lazy eye, occurs when the brain and eyes don’t work well together and leads to problems with reading, driving and depth perception. Strabismus, or crossed eyes, can also lead to failing eyesight. Astigmatism leads to blurred vision and can cause troubles with math and reading.
The conditions are treatable at an early age. But some become much more difficult or impossible to fix by the time children make it to high school. Even when vision can be improved later, children have already lost crucial time for learning.
Lael Lambert, assistant chief of child health services for the Marin County Department of Health and Human Services, said in an email that Marin only had one optometrist willing to accept Medi-Cal back in 2009. Since then, the county worked to encourage providers to participate and helped to simplify billing, she said.
“Access to vision services has significantly increased for children in Marin since 2009,” she said.
Robb Layne, director of government and public affairs for Partnership HealthPlan, said the percentage of children accessing vision services is on the upswing in recent years.
“We can’t take responsibility for the uptick in increased utilization,” he said. “We can say we were part of the solution.”
Many also point to recent efforts by the Marin Community Clinics, which in 2013 began to partner with University of California at Berkeley’s School of Optometry to have residents see clinic patients. The clinic is a federally qualified health center and can bill the government for seeing Medi-Cal patients at a higher rate than private providers.
Linda Tavaszi, the CEO of Marin Community Clinics, said optometry has been a “long, long unmet need in the community.”
“We had the schools telling us: what are we supposed to do with the kids? They cannot see,” she said. “It is absolutely true that there were very few services.”
The addition of optometry to the clinic’s offerings has been met with “unbelievable response and unbelievable unmet needs,” she said.
On a recent afternoon, Amelia Mora Arano came into the clinic in San Rafael with her 11-year-old daughter, Amelie.
Arano said she knew her daughter needed glasses when she started complaining of headaches and couldn’t see the chalkboard.
“Mom,” Amelie told her, “I’m getting confused.”
At first, it was hard finding doctors, Arano said, because so few accept patients with Medi-Cal. Like many Latino parents, she said, she also hadn’t been aware of what services were available to her children.
Other parents say locating a provider continues to be a challenge.
“Finding any doctor that will accept Medi-Cal is almost nonexistent in Marin County,” said Lisa Almquist, who has worked as both a hair stylist and a bookkeeper. She went online to look for providers after a teacher noticed her 7-year-old daughter, Dyllan, squinting in class.
Almquist eventually found Day’s Larkspur office.
Day says she decided to accept Medi-Cal long before she became an optometrist. She grew up in poverty, and as a student at University of California at Davis ended up on Medi-Cal after giving birth to her daughter.
Since Obamacare expanded the eligibility for Medi-Cal, she said, a much broader swath of the local population has the government insurance, many of them educated, working people like Almquist. She suspects this change will begin to chip away at some of the local stigma surrounding the Medi-Cal program.
“These kids are people,” she said. “They are not on Medi-Cal forever. Our job is to help them become successful, so they don’t need to be on it.”