Access to pediatric eye care among Medicaid-insured children in North Carolina.

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.

Duke Scholars

Author Nathan Cheung Ophthalmology

Author Sharon Fridovich Freedman Ophthalmology