Medi-Cal’s reliance on prisoners to make cheap glasses proved to be short-sighted

To avoid the hefty cost of glasses, Medi-Cal, California’s health insurance program for low-income people, has an innovative strategy: it contracts exclusively with state prisons and makes glasses for its inmates.

But the partnership, which began more than 30 years ago, has broken down. Medi-Cal registrants, many of whom are children, and their eye care providers say they often wait months for glasses and sometimes they break.

“I understand the goal of trying to give prisoners a decent job,” said Kelly Hardy, senior managing director of health and research at Children Now, a California-based child advocacy group. “But not at the expense of being able to see the kids.”

Medi-Cal’s agreement with the California Prison Industry Authority, or CALPIA, a business venture within the California Department of Correction and Rehabilitation that employs detainees, has been in operation since 1988. Other Medicaid programs – including Massachusetts and North Carolina – rely on prison labor to deliver on their promise of vision benefits.

Experts point out, however, that such innovations only work when patients receive glasses on time. Complaints from consumers and eye professionals have led California lawmakers to consider an expensive proposal that would allow Medi-Cal to buy glasses from retail labs.

Jane Angel, a San Francisco resident, said her 6-year-old son, David Morando, waited two months to get his glasses. She needed them because “she sits in the back of her classroom,” Angel said. He worries because David is also on the autism spectrum, so another reason he can’t see is that it’s hard for him to concentrate in class. “He’s not able to see the board, and it’s hard for him to learn,” Angel said.

Optometrists have also been frustrated by slow change times and frequent prescription errors.

“There’s nothing we can do to get the glasses fast,” said Joy Gray, office manager at Mission Vizor’s Alpert Eye Care. His clinic tracks pending spectacle orders, leaving empty trays for each on a shelf. A few months ago, so many CALPIA orders were pending that Gray and his colleagues were running out of space for others. “That’s how we backlog,” he said.

One-third of California – 40% of the state’s children, including about 5.2 million children – are enrolled in Medi-Cale. Medicaid provides vision benefits for children as needed by the federal government. Medi-Cal usually covers regular eye examinations and a pair of glasses every two years for this age group. In January 2020, the California program expanded the benefits to adults.

Spectacle orders from Medi-Cal to CALPIA increased from about 490,000 in 2019 to 654,000 in 2020 and then to 880,400 in 2021.

Medi-Cal pays CALPIA about $ 19.60 per pair of glasses, said Katherine Ware-Abstar, spokeswoman for the California Department of Health Care Services.

In an unscientific survey of its 171 members in March, the California Optometric Association found that 65% of respondents waited one to three months for glasses ordered for Medi-Cal patients. In comparison, the study found that the average change time of glasses from private labs was less than 15 days.

But Calpia spokeswoman Michelle Kane said production was moving much faster than that. He said orders were fulfilled from 2011 to 2020, on average, five days after labs received them, but the timing of the Covid-19 epidemic began to slip and peaked with a 37-day average in January 2021. Since then, he added, waiting times for orders have improved and reached nine days by April 2021 and are expected to return in five days this month.

To speed up ordering Medi-Cal glasses, Ken said, Calpia has entered into agreements with nine “backup” labs. There are five states outside of California. Of the 880,400 orders CALPIA received last year, 54% were sent to contracted private labs, Ken said. These labs send the glasses to CALPIA, which then mails them to the ordered clinics.

Kane blamed the prison lockdown and restrictions imposed by the Covid epidemic that he said were previous system hiccups that could increase production in the prison’s optical labs.

In the study, however, more than half of ophthalmologists said they did not see significant improvement during the change.

A bill under consideration by the California Legislature seeks to address the problem by eliminating the monopoly of the system and allowing clinics to order spectacles from retail labs.

The measure is a response to the shocking inequality at the level of optical care that the state provides to some of its most vulnerable residents, the bill’s sponsoring state senator Scott Wilk (R-Santa Clarita) said in a written statement.

But it has a big price tag. An analysis by the California Department of Healthcare Service, cited by lawmakers supporting the bill, estimates that the cost of Medi-Cal for a pair of glasses from a private lab will be 141% higher than it pays CALPIA.

CALPIA recruits 295 inmates for optical programs in three prisons: Valley State Jail in Chowchilla; Solano, California State Jail, Vacaville; And, most recently, the Central California Women’s Facility in Chauccilla. When the women’s benefit optometric program is fully operational, expected this month, the total will be 420.

One of the benefits of the partnership is that inmates learn skills they can use to get jobs after they finish their sentences. It also works to reduce the rate of reconsideration, Ken said.

Anthony Martinez, 40, knows the advantages and disadvantages of the system He was imprisoned in 2000 at the age of 19. For the last three years of his decade-long sentence, he worked on the prison’s optical program. “It was an opportunity I was going to take full advantage of,” Martinez said.

The day after his release, Martinez received a license from the American Board of Opticians to make and sell glasses. A month later, he was hired as a lab technician at a lenscraft in Los Angeles and was eventually promoted to lab manager. By 2020, he had helped open three more spectacle stores across the state.

Martinez is aware of the benefits he has gained from his experience in CALPIA’s optical program but understands the long-awaited effects on patients, especially children.

“I think it needs to run better,” Martinez said. “I mean, being there, I understand that for this kind of work you have to have quality and precision.”

Dr. Premila Banwight, a pediatric optometrist at the University of California-San Francisco, says that in addition to experiencing long-term changes, she has found many glasses for Medi-Cal patients that have been broken.

Kane says CALPIA will definitely remake orders for less than 1%.

Clarice Waterfield, 64, who lives in Paso Robles, had trouble with her order.

Waterfield’s diplopia, or double vision, and a vision that blurs his vision. He’s a personal buyer at grocery delivery company InstaCart, and without help, he says, boxes of cereals and crackers blend together. The aisle of the grocery store has become a big, long block.

About six weeks after ordering March 1, he received his glasses. He wore them with interest but saw that they were not the right prescription. They made his vision worse. “You could put a stuffed animal or something in front of my face, and all I could see was a big, fuzzy spot.”

The clinic had to be rearranged with glasses back. Six more weeks later, Waterfield found the right pair. But I remember his frustration.

“I was, ‘Are you kidding me?'” Waterfield recalls. “I’ve been waiting a long time for these glasses, and now that I have them, do I have to return them?”

The story was produced by KHN (Kaiser Health News), a national newsroom that creates in-depth journalism about health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), including policy analysis and polling. KFF is a non-profit organization that provides health information to the nation.

KHN (Kaiser Health News) is a national newsroom that creates in-depth journalism about health issues. KHN is one of the three main operating programs of KFF (Kaiser Family Foundation), including policy analysis and polling. KFF is a non-profit organization that provides health information to the nation.

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