CareSource

CareSource plans in Georgia

CareSource offers routine vision benefits to members enrolled in Medicaid.

 

Value-added benefits (VAB)

CareSource offers a VAB to Medicaid members aged 21 and older. They can use this VAB towards the purchase of frames or contact lenses. Refer to the EyeMed Georgia Medicaid Provider Manual for full details.

 

Materials

Eyewear lenses

Medicaid considers standard lenses to be CR-39 plastic single vision with scratch-resistant coating or glass.

• Polycarbonate lenses are covered for children.
• Tints are covered for adults only when medically necessary for conditions such as photophobia or albinism.
• Oversized lenses, UV protection, slab off lenses and high-index lenses are covered only when medically necessary.
• Any other lens types and options are not covered.

Refer to the EyeMed Georgia Medicaid Provider Manual (requires inFocus login to access) for full details

Contact lenses

Contact lenses are covered only when the patient has an eye disease or prescription that must be managed with contacts because eyeglasses cannot provide sufficient correction. The following Georgia Medicaid qualifying criteria will apply:

• For the treatment of a medical condition when adequate visual acuity cannot be obtained with glasses or for the treatment of disease (aphakia, keratoconus, corneal scars).

You’ll file medically necessary contact lens claims on paper using the Georgia Medicaid claim form.

 

Eyewear buy-ups

There are no buy-up options in the state of Georgia. If the Medicaid member wishes to purchase eyewear that exceeds their covered benefits, the member is responsible for paying out-of-pocket to cover the remaining costs.

 

Member ID cards 

Georgia Medicaid members will present CareSource ID cards like the ones below.

 

Related provider resources Provider Manual – Georgia Medicaid