State Medicaid agencies are required to cover Hepatitis C medications for people who have the disease or a substance use disorder, states were "encouraged" earlier this week.
In a joint letter by the Department of Justice and the Department of Health and Human Services, the agencies reminded states of their obligation, referring to an old settlement agreement between the DOJ and Alabama's Medicaid agency, or Alabama Medicaid.
Under the Americans with Disabilities Act, state Medicaid programs are not allowed to reject health services, such as administering HCV drugs to individuals with substance use disorder, if an individual is eligible.
In December 2022, Alabama Medicaid and the DOJ agreed to a settlement agreement, reversing an internal policy that prevented individuals from receiving HCV medication if the person had consumed alcohol or illicit drugs within six months of starting treatment, as well as prohibiting Medicaid payment. Alabama was forced to change its policies to not factor in a person's substance use when determining whether an individual was convered to receive HCV medications.
HCV can result in health conditions such as liver cancer, liver failure and death, but appropriate medications can cure HCV in more than 95% of cases, according to the Centers for Disease Control and Prevention. More than two million adults in the U.S. have HCV.
“Medicaid recipients with substance use disorders are entitled to the same access as others to a cure for Hepatitis C,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “This letter reminds state Medicaid administrators that they have an obligation to ensure their programs are in compliance with federal civil rights law."
The letter prompts states to review its current HCV policies and prior authorization practices to ensure compliance with the ADA, or otherwise risk enforcement.