Imagine being a kid who can’t see the board at school but doesn’t know how to tell your teacher. That’s the reality for thousands of California children on Medi-Cal who are going without proper vision care, and the problem is getting worse.

Kekoa Gittens’ story is a perfect example of how easy it is to miss vision problems in young kids. When he was three, his preschool teacher flagged that he couldn’t sit still and wasn’t participating in class. His mom, Sonia Gittens, didn’t realize the real issue until she took him to an eye doctor, who diagnosed him with myopic degeneration, a serious form of nearsightedness. “They are too little. They don’t know how to express themselves and say ‘I cannot see it, teacher,’” Gittens explained.

But Kekoa was lucky. A recent report commissioned by the California Optometric Association reveals that far too many kids aren’t getting their eyes checked at all. Just 16% of school-age kids on Medi-Cal received eye exams, follow-up vision care, or glasses between 2022 and 2024, down from 19% eight years earlier. That’s alarming when you consider that roughly one in four American school-age children wear glasses or contacts.

The problem is especially severe in rural counties. Colusa County, a farming region north of Sacramento, saw appointments plummet from 20% to just under 2% in the same timeframe. Nearly 81% of California’s counties are performing worse on vision care than they did in the past, with only seven counties actually improving their rates.

So what’s causing this crisis? Providers cite low reimbursement rates as a major factor. The California Optometric Association estimates that only about 10% of its members accept Medi-Cal, with reimbursement rates for comprehensive eye exams hovering around $47, a rate that hasn’t increased in 25 years. In rural areas, losing even one provider can devastate access to care. In Modoc County, a single optometrist serves a 90-mile radius.

Schools are supposed to screen kids’ vision starting in kindergarten, but that system has massive gaps. At one optometry clinic serving Pomona schools, up to 35% of students fail the screening, but only about 7% of those kids actually follow up with an eye doctor. Parents face barriers like transportation costs and time constraints, and notes from school nurses often get lost in backpacks.

Nonprofits like Vision to Learn are trying to fill this gap by bringing optometry clinics directly to schools. Their data is sobering: around 70% of kids prescribed glasses don’t own a pair, and another 20% wear outdated prescriptions. When kids finally get proper glasses, the difference is transformative. First and second graders are blown away when they realize they’ve never actually been able to see clearly before.

Today, Kekoa is 15 and thriving in high school. He needs clear vision to compete in capoeira and surf on weekends. But his story could have gone differently if his mom hadn’t pushed for answers. How many other California kids are falling behind in school because nobody caught their vision problems in time?