Kekoa Gittens was three years old when his preschool teacher told his mother something was wrong. He couldn’t sit still. He wouldn’t participate. While other kids traced the alphabet, Kekoa seemed checked out.
His mother, Sonia Gittens of Corte Madera, eventually took him to a pediatrician, who referred him to an eye doctor. The diagnosis: myopic degeneration, a severe form of nearsightedness. Kekoa wasn’t a problem child. He couldn’t see the board.
“They are too little. They don’t know how to express themselves and say ‘I cannot see it, teacher,’” Sonia Gittens said.
Kekoa is in high school now and doing well. But his early catch was the exception, not the rule. Across California, children on Medi-Cal are seeing eye doctors at declining rates, even as vision problems among kids become more common nationwide.
The Numbers Are Moving the Wrong Way
A report commissioned by the California Optometric Association found that just 16% of school-age kids on Medi-Cal received eye care between 2022 and 2024. That includes first-time exams, follow-up checkups, and glasses. Eight years earlier, that figure was 19%. The report draws on two years of Medi-Cal billing data.
That three-point drop matters because the baseline was already low. About one in four school-age children in the U.S. wear glasses or contacts, according to federal survey data. Medi-Cal covers low-income Californians and people with disabilities. The children enrolled in it are precisely the population least likely to have other options when the system falls short.
Ida Chung, a pediatric optometrist and associate dean at Western University of Health Sciences in Pomona, treats patients at a clinic where roughly half are on Medi-Cal. She said it is routine for children with congenital vision problems to show up for the first time in first grade or later.
“Every day when I see these children it is always a surprise to me that the kids are not getting the care they need,” Chung said.
School screenings and pediatric checkups catch some problems. But Chung said they miss others, particularly conditions children are born with. Those issues don’t announce themselves until a kid starts failing to keep up.
Rural Counties Are Hardest Hit
The statewide decline is bad. Some county-level drops are severe.
Colusa County, a rural farming region north of Sacramento, went from 20% of Medi-Cal kids receiving eye care in 2015 and 2016 to just under 2% between 2022 and 2024. That is not a rounding error. That is a near-total collapse in access.
Forty-seven of California’s 58 counties performed worse on children’s vision care than they did in earlier measured periods. Most of the sharpest declines came in rural areas, where provider shortages are already severe and transportation is a real barrier.
The structural problem is straightforward: there are not enough optometrists practicing in underserved areas, and Medi-Cal reimbursement rates have not made it financially viable for more to do so. A provider who loses money on each Medi-Cal appointment has limited options beyond seeing fewer Medi-Cal patients.
What Happens When Kids Can’t See
The connection between vision and academic performance is not subtle. A child who cannot read the board cannot learn to read. A child who strains to see a worksheet for years develops coping behaviors that look like disengagement or behavioral problems. Kekoa Gittens is a clear illustration of what misdiagnosed vision problems look like in a classroom.
The story was originally reported by CalMatters.
Chung put it plainly: by the time many of her patients reach her clinic, they are already behind.
Early intervention matters here more than in most areas of pediatric health, because the window for treating certain conditions is narrow. Some types of amblyopia, for example, are much harder to correct after age seven or eight. Missing that window is not just a short-term problem. It is a permanent one.
What Would Fix It
The report does not offer a single silver-bullet solution, but the general shape of the problem is clear enough.
Medi-Cal reimbursement rates for optometry services need to reflect the actual cost of care. California has raised Medi-Cal rates in some specialties in recent years, but optometry has not kept pace. Without rate parity, providers will continue to limit or avoid Medi-Cal patients, and access will keep declining.
Outreach and navigation matter too. Sonia Gittens got Kekoa to a specialist because his pediatrician made a direct referral. Many families do not get that hand-off. Vision care does not always feel urgent until a child is already struggling, and parents without a strong connection to the health care system may not know where to start.
School-based vision programs exist in parts of the state and could be expanded. They reach kids in the places kids already are. But they require funding, staffing, and follow-through to connect screenings to actual treatment.
California has 5.5 million children enrolled in Medi-Cal. Sixteen percent getting eye care means the other 84% are not. That is not a gap at the margins. It is the dominant outcome, and the trend line is still pointing down.