PORTLAND — The Maine Department of Health and Human Services is reviewing the fee that eye doctors receive to provide free glasses to low-income children since a local group of eye care clinics stopped dispensing glasses to MaineCare patients.

The $8 fee has been a growing problem for eye doctors and optical shops across Maine, and it’s unlikely to be increased anytime soon by a state department that’s facing a potential $23 million budget shortfall.

State officials surprised many eye care providers this week when they said that the dispensing fee had increased to $14.40 on Sept. 1, but that’s still less than half the amount that other states pay for the same service.

“The reimbursement rate is so low, most optical shops run at a loss,” said Dr. Jeffrey Berman, an ophthalmologist in Portland. “They’re being asked to subsidize the dispensing of eyeglasses to Maine children.”

Portland school officials have raised more than $4,000 for a fund they started last week to help buy glasses for students who cannot afford them, whether or not they’re covered by MaineCare.

The Portland Regional Chamber donated $1,000 to address a problem that could affect more than 500 students in Maine’s largest school district in the coming year.

“These youngsters are falling through the cracks of a system that is paying 1985 prices to doctors and expecting them to survive financially as a business,” said Superintendent Jim Morse. “Our students can’t succeed if they can’t see the white board or the page in front of them.”

Health and Human Services Commissioner Brenda Harvey said she plans to work with school officials and eye care providers in Portland to make sure low-income children continue to get the glasses they need.

She said her department was able to increase the dispensing fee this year because it saved money on a new bulk contract for frames and lenses. However, her department’s financial challenges mean another increase is unlikely this year, and legislative action would be necessary to increase the fee next year.

“None of us wants children to go without glasses,” Harvey said.

The issue came into focus this month when Portland students returned to school, said Amanda Rowe, the district’s head nurse.

School nurses encountered several students who said they were unable to get free glasses during the summer because no local optical shops would accept MaineCare, the state’s health insurance program for low-income families, senior citizens and people with disabilities.

The lack of willing providers became obvious after Casco Bay Eyecare, which has five offices in the Portland area, stopped providing glasses to MaineCare patients on July 1, said Rebecca Darling, the group’s administrator.

In recent years, more eye doctors and optical shops in Portland stopped providing glasses for the $8 fee, which was set in the mid-1980s.

Eye doctors increasingly limited their services to vision exams and medical treatments with MaineCare reimbursements that are more in line with actual costs.

By the spring, Casco Bay Eyecare’s two Portland offices were the only places in the city that were still providing glasses to MaineCare patients, unless they were willing to pay the entire cost themselves.

“For a while, we were the last ones standing,” Darling said. “We had so many MaineCare clients seeking glasses from us, we were on the verge of having to hire another optician. Our doctors agonized over this decision, but we couldn’t continue to operate at such a loss. If everyone does their share, it’s not such a burden, but we couldn’t do it alone.”

Most other states pay doctors $30 to $40 to dispense glasses, said Phil Goldthwait, an optometrist in Bangor who is president of the Maine Optometric Association. The group represents 190 optometrists across the state.

“This isn’t just a problem in Portland,” Goldthwait said. “This has been a problem across the state for more than 20 years.”

Optical shops that accept MaineCare must offer certain standard frames and prescription lenses that are provided at a bulk rate by an out-of-state vendor contracted by the state. For that reason, most discount optical chain outlets don’t accept MaineCare.

The dispensing fee covers the customer service and expertise involved in helping patients select frames, taking facial measurements for lenses, ordering glasses and making sure the prescriptions are correct when they arrive, and fitting finished glasses to patients.

It can take more than an hour to fit and dispense a pair of glasses, depending on the needs of each patient, and even $14.40 doesn’t cover the cost, Goldthwait said.

Berman, the ophthalmologist in Portland, said one-third of his patients at the Maine Eye Center use MaineCare, so it was a difficult decision when the clinic’s optical shop stopped providing glasses to MaineCare patients a year ago. He said he contacted MaineCare officials to discuss more affordable funding alternatives, but his suggestions went unanswered.

Now, MaineCare patients in Portland are being directed to providers that still honor the state program, but they’re as far away as Biddeford and Kennebunk. Berman said it’s only a matter of time before those providers give up, too.

“Their offices are going to be overwhelmed and they’re going to have to drop it as well,” he said.

 

Staff Writer Kelley Bouchard can be contacted at 791-6328 or at: [email protected]