HHS, DOJ letter urges Medicaid administrators to cover Hepatitis C, SUD medications

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The U.S. Department of Health and Human Services, along with the Department of Justice, have issued a joint letter to state Medicaid administrators urging them to ensure, in accordance with the Americans with Disabilities Act, that their Medicaid programs allow people who have both Hepatitis C (HCV) and substance use disorder (SUD) to access HCV medications called direct-acting antivirals (DAAs).

More than two million adults in the United States have HCV, which can result in a range of serious health conditions, including liver disease, liver cancer and death. However, highly effective DAA medications cure HCV in more than 95% of cases, the agencies said.

"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 Justice Department stands ready to enforce the ADA in order to eliminate unnecessary barriers that stand in the way of equal access to healthcare."

WHAT'S THE IMPACT?

The letter highlights a settlement agreement between the Justice Department and Alabama's Medicaid Agency to address a policy that denied Medicaid coverage for DAAs to patients who had consumed any alcohol or illicit drugs within the six months prior to starting treatment.

Alabama Medicaid's policy meant that people with HCV and SUD who also had evidence of recent use of alcohol and/or illicit drugs were denied potentially life-saving medication, the Department wrote. 

Following the initiation of an investigation by the department, Alabama Medicaid withdrew this policy and entered into an agreement to secure Medicaid coverage for such patients going forward. The agreement requires Alabama Medicaid to notify Medicaid recipients and providers in Alabama of these changes and promptly remedy any case where coverage for DAAs was denied because of a person's SUD.

The letter explains that both the Justice Department and HHS enforce the ADA with respect to state Medicaid programs. The ADA requires that states, in administering their Medicaid programs, provide individuals with disabilities, including SUD, equal opportunity to participate in and benefit from a state's Medicaid program.

The letter urges all state Medicaid administrators to review their current and forthcoming policies and practices, including those on HCV treatment, to determine if any changes are necessary to comply with the ADA.

"In the years that DAAs have been available, information and research regarding these products have increased," the departments wrote. "Prior authorization criteria and policies should be reviewed in light of these developments."

THE LARGER TREND

Although more needs to be done, Medicaid fee-for-service has improved throughout the years when it comes to patients with SUD being able to access treatment, according to a 2023 study published in JAMA Network. 

Researchers said these findings are "highly salient," given that just 10 states use Medicaid FFS and that state Medicaid FFS programs set the minimum standard for SUD treatment coverage in Medicaid MCO plans.

OUD treatment in particular has garnered increased attention in recent years as the opioid epidemic continues to affect the healthcare landscape. In September 2022, the U.S. Department of Health and Human Services awarded more than $1.6 billion in investments for communities throughout the country to address the addiction and overdose crisis.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.