Challenges with Medicaid Access for Pediatric Eye Care in Connecticut

Cassidy Friedl vividly recalls the day her son, Luca, was born. She held him close, almost unwilling to release him, even for a weigh-in. His physical features—softly chubby cheeks and bright orange hair that would eventually turn to a strawberry blond—captured her in a bit of disbelief.

However, a few months later, Friedl noticed a concern. Luca’s eye sometimes drifted inward, an issue that grew more visible over time. After mentioning it to his pediatrician, she was referred to a pediatric ophthalmologist.

Friedl researched and found Cara DeBenedictis, a pediatric ophthalmologist with excellent reviews. But when she called to set up an appointment, she learned it wouldn’t be available for nearly nine months.

Both Friedl and Luca were covered by HUSKY, Connecticut’s Medicaid program. Unfortunately, DeBenedictis’ office had only a few slots for HUSKY patients.

“It made my heart sink,” Friedl expressed, feeling frustrated that her child couldn’t receive timely, potentially vision-saving care simply due to her insurance.

Many independent healthcare providers have been limiting or refusing to see Medicaid patients, citing that the compensation they receive is inadequate. For years, doctors and lawmakers have voiced concerns about the insufficient payments for specialists treating Medicaid patients, arguing that it creates a significant burden, ultimately hindering patient access to necessary care. With HUSKY covering a quarter of Connecticut’s residents, including nearly half of the children, this situation poses broader implications for healthcare access throughout the state.

While there’s bipartisan support among lawmakers for Medicaid rate hikes, Gov. Ned Lamont’s proposals have often fallen short of what many deem necessary, with some years seeing no increases at all.

Chris Collibee, from Lamont’s budget office, stated the governor does favor sustainable increases but also emphasizes that large corporations need to assume more responsibility for employee health benefits rather than shifting costs onto taxpayers.

Decisions on Medicaid Acceptance

Medicaid, funded jointly by the federal and state governments, offers states considerable discretion regarding covered services, eligibility, and physician payments. In 2026, Connecticut updated its reimbursement rates, pushing them to about 60% of 2025 Medicare rates. Before this adjustment, rates had not broadly increased since 2008.

“It’s remarkable that any system would allow such stagnation in payment for 20 years,” remarked Janine Collinge, a pediatric ophthalmologist.

Doctors connected to hospitals usually follow their employers’ policies regarding Medicaid, but independent practitioners like DeBenedictis can make their own decisions. They often weigh whether they can afford to see patients who pay only a small portion of standard rates for services.

Despite 21 ophthalmology groups being enrolled in Medicaid, it’s unclear how many actively treat children or are accepting new patients. Currently, it’s estimated there are only around 10 pediatric ophthalmologists in Connecticut, with only half open to new Medicaid patients.

DeBenedictis noted her capacity for accepting new Medicaid patients is limited; she typically sees 30 patients daily but can only take on one or two new Medicaid cases, lest it becomes financially unmanageable. This situation is disheartening for her as there are always more children in need than she can provide for.

As a result, Friedl was fortunate to snag a cancellation that allowed Luca to see DeBenedictis in just four months, rather than waiting nine. After an examination, Luca was diagnosed with accommodative esotropia and amblyopia, leading to a prescription for glasses to correct his eye condition.

Collinge, when she first opened her practice in January 2025, accepted all patients, regardless of their insurance type. But covering costs became a challenge, as expenses like utilities and recruitment quickly eroded her income. She was forced to limit the number of Medicaid patients seen daily, eventually refusing to accept any new Medicaid patients by January 2026, deeming the state’s reimbursement increases insufficient for sustainability.

Collibee pointed out that long waits for pediatric ophthalmologists aren’t exclusive to Connecticut; a significant shortage exists nationally, affecting most counties in the U.S. yet adding that the dilemma is not directly tied to Medicaid reimbursement rates.

While Collinge acknowledged the national shortage, she noted it disproportionately affects those on Medicaid, saying, “It’s not just difficult; it’s more challenging for those with Medicaid.”

Wider Implications on Access

HUSKY serves approximately a quarter of Connecticut’s population but covers about half of the state’s children. A significant number of Black and Hispanic children are enrolled in the program, raising concerns about healthcare access disparities. DeBenedictis has observed these inequities, particularly in her Waterbury practice, expressing frustration that many kids are missing out on essential healthcare.

Martha Howard, a pediatric ophthalmologist at Yale Medicine, emphasizes that low Medicaid rates not only impact those on Medicaid but also extend to privately insured patients, citing long wait times for all children due to the intake of Medicaid patients at their facility.

Senator Jason Perillo pointed out that low Medicaid reimbursement rates contribute to higher insurance premiums for those with private insurance since hospitals compensate for these low rates by negotiating for higher payments from insurers.

Increased Pressure on Medicaid

Both DeBenedictis and Collinge have actively pressed Governor Lamont on this issue, though to limited effect. Collinge reports having faced him at numerous events, which has led to some level of recognition. “He says, ‘You’re the one with the Medicaid problem,’ and I reply, ‘Everyone has a Medicaid problem,’” she recounted.

While the Lamont administration acknowledges the need for rate updates, they’ve delayed comprehensive increases. A planned study led to some findings revealing that Connecticut’s Medicaid program pays less than surrounding states, yet no significant rate increases were made post-study.

Recent budgeting has allocated a bit more for physician reimbursement, but many, including Human Services Committee co-Chair Sen. Matt Lesser, insist that progress is lacking. Criticism has come from Rep. Jillian Gilchrest, who stated that current solutions are merely superficial against the underlying issues that need addressing.

A proposal was passed to raise Medicaid rates to 75% of Medicare by 2029 but ultimately never came to a vote. There’s hope for future proposals, but there’s a looming pressure of additional costs and federal cuts affecting social services that complicate the search for solutions.

Friedl believes that the state’s reluctance to invest more in Medicaid reflects a priority on finances over individual health and well-being. “Healthcare should not be a luxury,” she emphasized.