New legislation passed in Connecticut earlier this summer granted optometrists (ODs) Medicaid payment parity with ophthalmology for a significant portion of their eye health and vision care services.
Talk about a major optometric win …but first: let’s look at Medicaid.
Since Medicaid operates at both the federal and state levels, reimbursement rates for optometry versus ophthalmology vary by state, with each setting their own Medicaid schedules.
In optometry: The American Optometric Association (AOA) Health Policy Institute (HPI) previously reported that the vast majority of states have either never (or not recently) increased the reimbursement rate for primary eyecare vision services.
National stats to know (reportedly based on 2025-26 data from the Department of Social Services [DSS]):
- 167,384 Medicaid eye exams are performed by ODs
- 21,394 Medicaid eye exams are performed by ophthalmologists
- 88.6% of all Medicaid eye exams are performed by ODs
Related: Check out the AOA’s 2020 reporting on the undervaluing of these “stagnant fee schedules” for Medicare and Medicaid.
Now to Connecticut.
The legislation in question: Public Act No. 26-68—previously known as Connecticut House Bill (HB] 5561—covered a few (including non-eyecare) purposes.
And within this: Our focus is the Medicaid State Plan Amendment (SPA) 26-Z, which established a rate change impacting optometry via the state’s DSS.
Tell me about this.
For context: Medicaid reimbursement rates in Connecticut are implemented as code-specific maximum allowable fees rather than a single flat rate.
- And importantly: When compared to ophthalmologist vision services, OD vision service reimbursements have clocked in at just 90%—until now.
The update: Medicaid reimbursement rates have increased by 10% for four high-volume optometric services, essentially bringing payments “into parity with ophthalmology.”
… and which services are included?
Four specific CPT codes comprising “more than 85% of total optometric billings for Medicaid services,” according to the American Optometric Association (AOA):
- 92250: Comprehensive eye examination for a new patient
- 92014: Comprehensive eye exam for an established patient
- 92015: Refraction
- 92250: Fundus photography
See here for the state DSS’s official notice of the proposed SPA 26-Z in its entirety.
Let’s talk about impact.
The simple goal behind this rate increase: An expansion in patient access for vision care services across the state, per the AOA.
The expectation: For these update reimbursement rates to increase “annual aggregate expenditures” (in other words: spending more total money each year) for the state’s fiscal years (SFYs) by:
- $2,15,615 in SFY 2027
- $2,489,546 in SFY 2028
But also take note: Connecticut will continue to receive the statutory minimum federal reimbursement rate (50%) for its Medicaid expenses in FY 2027.
So what led to this decision?
Years of advocacy, largely from the Connecticut Association of Optometrists (CAO).
The state organization testified on two other occasions in support of prior Medicaid rate bills (in 2024 and 2025); the third time proved to be the charm, in this case.
- See here for a transcript of testimony from earlier this year.
And as a recent CAO member survey reported: 89% (an estimated 9 in 10) of Connecticut ODs treat Medicaid patients—and that number “was expected to rise to 93.% with higher reimbursements.”
Lastly: When will this update take effect?
It already did (on July 1).
*Disclaimer: The information provided in this article does not and is not intended to constitute legal advice; instead, all information, content, materials available herein are for general information purposes only.