California’s poor face delays inmate-made glasses

To avoid the high cost of eyeglasses, California’s low-income health insurance program, Medi-Cal, has an innovative strategy: It contracts exclusively with state prisons, and inmates make eyeglasses. for its beneficiaries.

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

“I understand the goal of trying to give prisoners a dignified occupation,” said Kelly Hardy, senior managing director of health and research for a California-based children’s advocacy group, Children Now. “But not at the expense of children who can see.”

Medi-Cal’s contract with the California Prison Industry Authorityor CALPIA, a commercial enterprise of the California Department of Corrections and Rehabilitation that employs inmates, has been in place since 1988. Other Medicaid programs — including those in Massachusetts and North Carolina — rely on the prison labor to fulfill the promises of their visual advantage.

Experts noted, however, that such innovations only work if patients receive their glasses in a timely manner. Complaints from consumers and eye care professionals have led California lawmakers to consider an expensive proposal that would allow Medi-Cal to buy eyeglasses from retail labs.

San Francisco resident Jane Angel said her 6-year-old son David Morando waited two months for his glasses to be delivered. He needed it because “he’s sitting at the back of his class,” Angel said. She’s worried because David is also on the autism spectrum, so not seeing is another reason he has trouble concentrating in class. “He’s not able to see the board, and it’s just hard for him to learn,” Angel said.

Optometrists, too, have been frustrated by slow turnaround times and frequent prescription errors.

“There’s nothing we can do to get the glasses any faster,” said Joy Grey, Alpert Eye Care’s office manager at Mission Viejo. Her clinic tracks pending eyeglass orders by keeping empty trays for each on a shelf. A few months ago, so many CALPIA orders were backlogged that Gray and his colleagues were running out of space for others. “That’s how late we are,” she said.

A third of Californians — including 40 percent of the state’s children, or nearly 5.2 million children — are enrolled in Medi-Cal. The federal government requires Medicaid to provide vision benefits for children. Medi-Cal generally covered routine eye exams and a pair of glasses once every two years for this age group. In January 2020, the California program extended benefits to adults.

Orders for glasses from Medi-Cal to CALPIA increased from nearly 490,000 in 2019 to 654,000 in 2020 and then to 880,400 in 2021.

Medi-Cal pays CALPIA about $19.60 for each pair of glasses made, said Katharine Weir-Ebster, spokeswoman for the California Department of Health Services.

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

But CALPIA spokeswoman Michele Kane said production was moving much faster than that. She said orders from 2011 to 2020 were filled, on average, five days after labs received them, but turnaround times began to slip during the COVID-19 pandemic and peaked in January 2021. with an average of 37 days.

Since then, she says, wait times for orders have improved. They reached nine days in April 2021 and are expected to return to five days this month.

To speed up the fulfillment of orders for Medi-Cal glasses, Kane said, CALPIA is contracting with nine “backup” labs. Five are in states other than California. Of the 880,400 orders received by the prison service last year, 54% were sent to private laboratories under contract, Kane said. These laboratories send the glasses to CALPIA, which then sends them to the clinics that have ordered them.

Kane blamed prison closures and restrictions triggered by the COVID-19 pandemic for exacerbating what she previously said were system misfires that could upend production at prison optical labs.

In the survey, however, more than half of optometrists said they had not seen turnaround times improve significantly.

A bill under consideration by the California legislature seeks to address the issue by removing exclusivity from the arrangement and allowing clinics to also order eyewear from retail labs.

The measure is a “response to the shocking disparity in the level of optical care the state provides to some of its most vulnerable residents.” State Senator Scott Wilk (R-Santa Clarita), the bill’s sponsor, said in a written statement.

But it comes at a big price. A California Department of Health Services analysis, which has been referenced by lawmakers supporting the bill, estimates that the cost to Medi-Cal of a pair of glasses from private labs would be 141% higher than he pays CALPIA.

CALPIA employs 295 inmates for optical programs at three prisons: Valley State Prison in Chowchilla; California Solano State Prison in Vacaville; and, most recently, the Central California Women’s Facility in Chowchilla. When the optometry program at the women’s facility is fully operational, expected this month, that total will be 420.

One of the benefits of the partnership is that inmates learn skills they can use to get a job after serving their sentence. It also works to reduce recidivism rates, Kane said.

Anthony Martinez, 40, knows the pros and cons 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 in the prison’s optical program. “It was an opportunity that I was going to take full advantage of,” Martinez said.

The day after his release, Martinez obtained a license from the American Board of Opticianry to manufacture and sell eyeglasses. A month later, he was hired as a lab technician at LensCrafters in Los Angeles and was eventually promoted to lab manager. By 2020, he had helped open three more eyewear stores across the state.

Martinez is aware of the benefits he has gained from his experience in CALPIA’s optics program, but understands the impact that long wait times have on patients, especially children.

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

Dr. Premilla Banwaitpediatric optometrist at UC San Francisco, said that in addition to experiencing long turnaround times, she received many broken glasses for Medi-Cal patients.

Kane said CALPIA must redo less than 1% of orders.

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

Waterfield has diplopia, or double vision, and astigmatism which causes his vision to be blurry. She’s a personal shopper for grocery delivery company Instacart, and without seeing help, she says, boxes of cereal and crackers get mixed up. Grocery store aisles become big, long blocks.

She got her glasses about six weeks after ordering them on March 1. She put them on impatiently, but found that they were the wrong prescription. They worsened his vision. “You could have been holding a stuffed animal or something right in front of my face, and all I could see was a big blurry spot.”

The clinic had to return the glasses and order them again. After another six weeks, Waterfield received the correct pair. But she remembers the frustration.

“I was like, ‘Are you kidding me?'” Waterfield recalled. “I waited too long for these glasses, and now that I have them, do I have to return them?”

This story was produced by KHN (Kaiser Health News), one of the three main operating programs of KFF (Kaiser Family Foundation).

Sarah C. Figueiredo