Since the fall of 2008, the American Optometry Association (AOA) has advocated for the inclusion of optometry services in the definition of preventative and primary care under the Federally Qualified Health Centers (FQHC).¹  The 36,000 member AOA made numerous concerted efforts to promote optometry as a primary care health service, including: establishing the AOA Community Health Centers (CHC) Committee; holding numerous meetings with the Health Resources and Services Committee (HRSA); and, forming EyeTAC, the AOA-based consulting service.²  The AOA’s goal has been achieved, as the Patient Protection Affordable Care Act (ACA) has included vision care in its definition of preventive and primary health.³ 

The ACA designates $9.5 billion for the construction of new health centers in underserved areas and the expansion of preventive and primary health care services, including vision services, at existing health center sites over the next five years.⁴  The Expanded Services (ES) initiative established by the ACA  has been allocated $335 million of this funding to “boost access to primary health care,” according to an October 26, 2010 announcement by Kathleen Sebelius, Director of the Department of Health and Human Services (HHS).⁵  Existing health centers, as defined under Section 330 of the Public Health Service Act (PHS), are eligible to apply for the ES initiative funding.  To receive funding, applicants must expand their existing primary care medical capacity to underserved populations in their area, and must propose to use the funds to begin directly providing or to expand existing primary care services.⁶  Vision services eligible for this funding include comprehensive eye exams and specialty (or clinical) services.⁷ The deadline to apply for ES funding is January, 6, 2011.⁸

It is important to note that the guidelines provided by the HRSA regarding allocation of the ES funding may minimize the effect that these funds have on vision care.  Health centers will be required to allocate at least two-thirds, and up to 100 percent, of their federal funding toward “Expanded Medical Capacity” (EMC) of currently-designated primary care services. Service expansion proposals – which encompass vision care, oral health, behavioral health, pharmacy services, and enabling services – may be submitted, but are not required.  Consequently, health centers need not incorporate vision care expansion into their plan in order to qualify for ES funding.  If a center does chose to allocate funds for service expansion, only up to one-third will be available for this purpose, which will then be divided between the four qualifying services.⁹

Despite the limitations presented by the guidelines, the availability of funds for vision care expansion is unprecedented.  Advocates for the inclusion of vision care as a primary care service should view this as a starting point for primary vision care, and health centers should welcome the opportunity to provide an additional service to patients who otherwise may not be able to afford the care.