Does Medicaid cover contacts or LASIK?
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Contacts only when medically necessary and the state's vision benefit allows them; LASIK is treated as elective and is not covered. Federal rule: state option (contacts); not covered (lasik).
What federal law says
Federal regulation covers 'other aids to vision' alongside eyeglasses in 42 CFR 440.120(d), which is where contact lenses can fit. Most states that cover adult vision limit contacts to medical necessity: a condition that glasses cannot correct, such as keratoconus, severe anisometropia or aphakia. Contacts chosen for convenience or appearance are not covered.
Refractive surgery such as LASIK or PRK has no federal category and is treated by state programs as elective, since glasses or contacts correct the same problem. We found no state Medicaid program that covers LASIK for ordinary nearsightedness.
The exception is reconstructive: corneal surgery for disease or injury is a physician service covered under medical necessity, which is a different thing from refractive surgery.
Children under 21
Under EPSDT a child can get contact lenses when glasses cannot correct the condition, for example keratoconus or after cataract surgery.
What to ask your state plan
- If glasses cannot correct your vision, ask the eye doctor to document why; that note is what turns contacts into a covered medical necessity.
- Find your state's agency, program name and phone on Medicaid by state.
Related questions
Common questions
Does Medicaid cover contacts or LASIK?
Contacts only when medically necessary and the state's vision benefit allows them; LASIK is treated as elective and is not covered.
Does Medicaid cover contact lenses and LASIK for children?
Under EPSDT a child can get contact lenses when glasses cannot correct the condition, for example keratoconus or after cataract surgery.
How do I find out whether my state's Medicaid covers contact lenses and LASIK?
Three places. Your plan's member handbook or benefit summary, which lists the covered services and limits; the state Medicaid agency's provider manual for the service, which is public and states the medical-necessity criteria; and the member services line on your card, which can run a coverage check for a specific procedure code. Our state pages list each agency's phone and portal.
Sources
- 42 CFR 440.120 (prescribed drugs, dentures, prosthetic devices, eyeglasses)
- 42 CFR 440.230 (amount, duration and scope of services)
- medicaid.gov: EPSDT (children under 21)
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