PDFWAC 182-544-0575
Vision care—Noncovered eyeglasses and contact lenses.
(1) The agency does not cover the following:
(a) Executive style eyeglass lenses;
(b) Bifocal contact lenses;
(c) Daily and two week disposable contact lenses;
(d) Extended wear soft contact lenses, except when used as therapeutic contact bandage lenses or for aphakic clients;
(e) Custom colored contact lenses;
(f) Glass lenses;
(g) Nonglare or anti-reflective lenses;
(h) Progressive lenses;
(i) Sunglasses and accessories that function as sunglasses (e.g., "clip-ons");
(j) Upgrades at private expense to avoid the medicaid agency's contract limitations (e.g., frames that are not available through the agency's contract or noncontract frames or lenses for which the client or other person pays the difference between the agency's payment and the total cost).
(2) A noncovered service may be requested as an exception to rule (ETR) as described in WAC 182-501-0160.
(3) For clients age 20 and younger, providers must follow the rules for the early periodic screening, diagnosis, and treatment (EPSDT) program, see chapter 182-534 WAC.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-21-142, s 182-544-0575, filed 10/21/25, effective 11/21/25; WSR 17-14-067, § 182-544-0575, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0575, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0575, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0575, filed 6/24/08, effective 7/25/08.]