CVHS-UVMMC Vision Access Initiative

Bridging the Gap Between Screening and Treatment: Ensuring No Child's Vision is Lost to Transportation Barriers

Jasmine Bazinet-Phillips, M.S.Ed. (1)

(1) The Robert Larner, M.D. College of Medicine at The University of Vermont

VT anticipates major disruptions to its healthcare infrastructure due to the One Big Beautiful Bill Act (passed June 2025). State analysts project a $211 million cumulative loss in Medicaid funding by 2032, stripping health insurance from approximately 45,000 Vermonters. These cuts threaten the sustainability of essential programs, particularly those supporting low-income families.

Head Start, founded in 1965, delivers vital services to children ages 0-5. Champlain Valley Head Start (CVHS) provides annual vision screenings but faces persistent barriers to ensuring follow-up subspecialty care due to transportation barriers and long wait times at UVMMC. Children under age 3 have a follow-up rate of 33%, compared to 62.3% for children aged 3-5, despite research recommending amblyopia detection by 36-48 months (Delpero et al., 2019).

Transportation is a critical missing link between diagnosis and treatment. CVHS participants referred to UVMMC are eligible for free glasses through VT’s Dr. Dynasaur Medicaid program. However, a lack of reliable transportation prevents many families from consistently attending appointments. CVHS does not have a dedicated transportation budget. Instead, it relies on limited emergency funds, $1,000 annually to cover transportation costs only when no other alternatives are available. The distributed demand of CVHS emergency funds can greatly vary. Recently, CVHS paid an outstanding $300 dental bill to ensure a CVHS participant could resume essential exams.

In the summer of 2023, the CVHS-UVMMC Vision Screening Program (VSP) began informally at Fletcher Free Library and was driven by concern over post-COVID-19 trends like increased screen time and reduced outdoor activity for children, which contributed to a rise in pediatric vision concerns. Before the pandemic, CVHS used local taxi services, but as COVID-19 disrupted the local taxi structure, CVHS launched an Uber Health (UH) account in 2023. The $500 2024 Aequitas Health Project Grant was added to the UH account to support rides to and from UVMMC for vision follow-up appointments. The system is in place for the 2025-2026 program year, and funds are expected to be distributed this Fall.

In Fall 2024, at the first annual CVHS-UVMMC community-based screening, 11 of 14 children attended. Approximately 50%, 6 children aged 1.5-4, were referred to UVMMC for follow-up subspecialty care, with 8 appointments scheduled. Only one participant was lost in the follow-up sequence. Seven of the eight appointments (87.5%) were attended, with half of those children requiring an additional round of scheduled care. These figures suggest early impact due to an intentional hospital-community-based partnership, but further gains are expected with ride-share funding in place. The group has a pending proposal to share results at the upcoming UVMMC 2025 Health Equity Summit scheduled for October 23 – 24th, 2025.

With VT facing sweeping Medicaid losses (VTDigger, July 2025), partnerships like CVHS-UVMMC are essential for sustaining equitable care. Although the Aequitas funds remain unused to date, the grant has already strengthened planning and readiness for the upcoming school year, ensuring that no child’s vision or Kindergarten readiness is compromised due to a lack of transportation.

References:

1. Alah, M. A., Abdeen, S., Bougmiza, I., & Selim, N. (2024). Screen time soars and vision suffers: How school closures during the pandemic affected children and adolescents’ eyesight. Journal of Prevention. https://doi.org/10.1007/s10935-024-00800-3

2. Chaiyachati, K. H., Hubbard, R. A., Yeager, A., Mugo, B., Shea, J. A., Rosin, R., & Grande, D. (2018). Rideshare-based medical transportation for Medicaid patients and primary care show rates: A difference-in-difference analysis of a pilot program. Journal of General Internal Medicine, 33(6), 863–868. https://doi.org/10.1007/s11606-018-4306-0

3. Delpero, W. T., Robinson, B. E., Gardiner, J. A., Nasmith, L., Rowan-Legg, A., & Tousignant, B. (2019). Evidence-based clinical practice guidelines for the periodic eye examination in children aged 0–5 years in Canada. Canadian Journal of Ophthalmology, 54(6), 751–759. https://doi.org/10.1016/j.jcjo.2019.09.003

4. Guo, J., Bard, J. F., Morrice, D. J., Jaén, C. R., & Poursani, R. (2021). Offering transportation services to economically disadvantaged patients at a family health center: A case study. Health Systems, 11(4), 251–275. https://doi.org/10.1080/20476965.2021.1936658

5. VTDigger. (2025, July 3). Vermont officials estimate 45,000 people to lose health insurance under Trump’s tax bill. https://vtdigger.org/2025/07/03/vermont-officials-estimate-45000-people-to-lose-health-insurance-under-trumps-tax-bill/

6. Wong, C. W., Tsai, A., Jonas, J. B., Ohno-Matsui, K., Chen, J., Ang, M., & Ting, D. S. W. (2021). Digital screen time during the COVID-19 pandemic: Risk for a further myopia boom? American Journal of Ophthalmology, 223, 333–337. https://doi.org/10.1016/j.ajo.2020.07.034