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Medicaid & Eye Care

Medicaid is a lifeline for millions of patients who depend on ophthalmologists for vision-saving care. The Academy works with the American Medical Association and the physician community on opportunities to protect patients’ access to care.

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Where We Stand

The Academy is deeply concerned about the Medicaid cuts enacted in the One Big Beautiful Bill Act (H.R. 1, P.L. 119-21), signed into law on July 4, 2025. The law imposes the largest cuts to Medicaid in the program’s history — nearly $1 trillion in reduced federal spending over ten years — and is projected to leave millions of Americans without health coverage. For ophthalmology, this means fewer patients able to access the eye care they need, lower reimbursement rates, and mounting pressure on practices that serve underserved communities. The Academy opposed these cuts and will continue to advocate for policies that protect Medicaid patients’ access to quality ophthalmic care.

What We’re Doing

Monitoring Implementation of Medicaid Cuts

The Academy is closely monitoring implementation of the One Big Beautiful Bill Act (H.R. 1, P.L. 119-21), including new work requirements, restrictions on state financing mechanisms, and reduced federal matching rates, and how Medicaid beneficiaries and the clinicians that treat them are impacted. The Academy will alert members to implementation developments and action opportunities as they arise. 

Advocating for Medicaid Coverage of Collagen Cross-Linking in New York

The Academy, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), the Cornea Society, and the New York State Ophthalmological Society (NYSOS) jointly sent a letter to the New York State Department of Health (NYSDOH) advocating for Medicaid coverage of epithelium-off collagen cross-linking (CXL) for patients diagnosed with progressive keratoconus. The procedure — billed under CPT code 0402T — is the only FDA-approved treatment proven to halt the progression of keratoconus. Our letter urged New York Medicaid to extend coverage to patients of all ages when medically necessary and to provide fair reimbursement covering both the procedure and the required medications (J2787, riboflavin 5’-phosphate ophthalmic solution, up to 3 ml; brand names: Photrexa Viscous and Photrexa). The Academy is awaiting a response from the department and will monitor announcements on a final coverage determination. 

Monitoring State-Level Fallout

Because the new law shifts substantial costs to states — reducing state Medicaid budgets by an estimated $665 billion over ten years — states will face intense pressure to cut provider rates, restrict eligibility, or eliminate optional benefits, including vision care.  

Latest News

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Congress Expected to Pass GOP Reconciliation Budget Bill

The U.S. Senate has approved a Republican budget reconciliation bill that would give doctors a one-year 2.5% Medicare payment increase  in 2026 and makes major changes to the Medicaid program. The House is expected to vote on the legislation later on Thursday after an all-night session.
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Ophthalmic Community Urges Medicaid Coverage for Collagen Cross-Linking in NY

The Academy, American Association for Pediatric Ophthalmology and Strabismus (AAPOS), Cornea Society, and New York State Ophthalmological Society (NYSOS) have jointly sent a letter (PDF) to the New York State Department of Health (NYSDOH) advocating for Medicaid coverage for epithelium-off collagen cross-linking for patients diagnosed with progressive keratoconus.
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Medicaid Update: House Committee Advances Major Modifications

The bill could significantly impact the number of people eligible for Medicaid. Follow updates on this developing issue on our live webpage.

What You Can Do

Monitor state-level changes

As states absorb federal funding reductions, optional Medicaid benefits — including vision services — are at risk. Stay alert for state budget developments and be ready to engage.

Support collagen cross-linking coverage

If you treat keratoconus patients in New York or other states where CXL remains uncovered by Medicaid, contact the Academy’s Health Policy and State Affairs teams at healthpolicy@aao.org to share your clinical experience.

Invest in OPHTHPAC

Donate to OPHTHPAC and help build the congressional relationships needed to defend Medicaid patients’ access to ophthalmologic care in the years ahead.

Tell your story

Share how these cuts affect your patients and practice. Contact politicalaffairs@aao.org.

Background

Medicaid is the nation’s primary public health insurance program for low-income individuals and families, jointly funded by the federal government and states. It is among the most important payers of eye care services for underserved populations — including children, adults with disabilities, and low-income seniors. For many patients, it is their only path to vision-saving treatment. 

The One Big Beautiful Bill Act (P.L. 119-21), signed July 4, 2025, makes some of the most sweeping changes to Medicaid since the program’s creation. Key provisions include new work requirements for able-bodied adults without dependents, restrictions on state-directed payments and provider taxes that states have long used to fund their share of Medicaid and reduced federal matching rates. The Congressional Budget Office (CBO) projects the law will result in 11.8 million more uninsured Americans over the next decade. 

For ophthalmology, the downstream effects are significant. Reduced enrollment means fewer covered patients. States under fiscal pressure are likely to cut optional benefits first — and adult vision care is commonly among them. Lower provider payment rates could make it difficult for practices, particularly those in rural and underserved areas, to continue accepting Medicaid patients.  

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Ophthalmic Community Urges Medicaid Coverage for Collagen Cross-Linking in NY