Opinion: California Undervalues Eye Care for Our State’s Most Vulnerable Citizens

Vision is our most precious sense. It allows us to learn, grow, work, and connect. But for too long California’s leaders have undervalued the importance of eye care for the most vulnerable among us.

Gov. Gavin Newsom is failing to see the big picture with his decision to delay increasing how much the state pays optometrists to provide eye care for those on Medi-Cal. After initially offering support for an increase, Newsom has backtracked in his revised 2024-25 budget plan.

What’s more important than a child being able to see and learn, or for someone struggling to support their family to see well enough to drive and perform their duties at work?

As a practicing optometrist for more than two decades, I see every day how eye care makes a difference in the lives of individuals and families who rely on the state’s Medi-Cal program. Yet over that time it has become increasingly difficult for my patients to access vital eye care.

That’s because, even as the costs for optometrists to run our practices have climbed dramatically, the rate the state pays to eye doctors hasn’t budged. This has forced some eye doctors to stop accepting the state insurance program altogether. While the state has recognized the need to pay other physicians and medical specialists more to ensure access for Medi-Cal patients, eye doctors have been left out for 21 years.

Having practiced in California for nearly two decades, I own and manage nine practices, including four that accept Medi-Cal. Although I’d like to accept Medi-Cal in at least one more of my locations, it is simply too expensive as the state rate covers only around half my cost to provide a comprehensive eye exam.

Sadly, without a reimbursement rate increase, the rising costs of business will force me to eventually decide between accepting the state aid and keeping some of my practices open.

It is an impossible choice.

Keeping practices open without accepting Medi-Cal means not being able to fulfill the reason I became an eye doctor, to truly serve the community. Without my services in local communities, many of my patients say they would face impossibly long drives and months-long waits for healthcare; many are Spanish-speaking and struggle to find providers who understand their culture and speak their language.

In some areas, often in rural and low-income neighborhoods, optometrists provide the frontline of medical care for residents. In some cases, we are the only healthcare provider that patients can get in to see and we often identify serious health problems such as diabetes and cancer — diseases in which early detection improves outcomes –that might otherwise have been missed.

Already, our patients report having to go far from home to find an optometrist who accepts Medi-Cal. If California fails to increase reimbursement rates for eye doctors, providers will become even fewer and farther between.

One out of every 10 optometrists in California report that they have left the Medi-Cal program in the last two years. Many who do not participate in Medi-Cal give low rates as the primary reason.

This particularly does a disservice to California’s children. According to the CDC, one in four children have some form of vision problem but just 15 percent of preschoolers receive an eye exam.

I cannot bear the thought that I might have to cease offering Medi-Cal in locations that have accepted it for more than 65 years in some cases. But I also need to pay my staff fair wages so they can survive in this challenging economy.

Although we are the state with the highest cost of living, California’s reimbursement rate to optometrists for eye exams is the third lowest in the nation, ahead only of Rhode Island and New Jersey.

I recognize that the state faces a difficult budget situation. In making the best choices for our state, I urge Gov. Newsom and lawmakers to consider the impacts of failing to deliver eye care for our vulnerable Medi-Cal population. Without good vision, my elderly or diabetic patients struggle to inject their medicine. They can’t go out and be active in the community as much, leading to other health issues.

California is doing the right thing to expand Medi-Cal to provide critical healthcare services to more Californians and improve timely access to Medi-Cal providers. But doing so without raising reimbursement rates for optometrists is a truly short-sighted approach that will lead to fewer providers and less access for patients.

I implore lawmakers to consider California children, families and seniors and include a long overdue reimbursement increase in the upcoming budget.

Dr. David Ardaya has practiced optometry since 2003. He sees patients in Whittier and manages nine optometry practices in Southern California. In 2022 Dr. Ardaya was named Optometrist of the Year by the California Optometric Association.