Harvard Center for Health Law and Policy Innovation Flags HCV Treatment Denials for People with Substance Use Disorder as Illegal

The Center’s new legal theory could help Alabamians who are enrolled in Medicaid access curative HCV treatment.

Yesterday, the Center for Health Law and Policy Innovation (CHLPI) of Harvard Law School, in partnership with AIDS Alabama, filed a complaint with the U.S. Department of Justice, alleging that Alabama’s Medicaid program is illegally denying lifesaving treatment for hepatitis C (HCV) to people with substance use disorder.

HCV is the deadliest bloodborne illness in the U.S. While effective and curative direct-acting antiviral (DAA) treatments have been available for nearly a decade, CDC data shows rates of HCV tripled in the U.S. between 2009 and 2019, an increase that has been associated with a rise in opioid use. Despite this increase, some state Medicaid programs restrict access to HCV treatment in conflict with the medical standard of care.

Alabama Medicaid has a policy of denying lifesaving treatment to people with HCV if they have used illicit drugs or alcohol in the past six months. CHLPI and AIDS Alabama argue that these restrictions violate the Americans with Disabilities Act, which protects people who are disabled due to substance use disorder.

“Forced sobriety policies don’t just unfairly prevent people with substance use disorder from accessing life-saving treatment; they also severely hamper public health efforts to stop the spread of the disease,” said Kevin Costello, CHLPI’s Litigation Director. “These policies are rooted in stigma, not science, and they violate antidiscrimination provisions of the Americans with Disabilities Act. Filing an administrative complaint against Alabama is an important milestone in fighting sobriety restrictions, and we fully intend to expand this enforcement campaign to all states where sobriety restrictions persist.”

“Alabama’s health outcomes always seem to be among the worst in the nation,” states Kathie Hiers, CEO of AIDS Alabama.  “Policies that prevent adequate medical care from being provided must end.  HCV now has a cure, and withholding that cure from Alabamians based on a moral judgement is wrong and certainly doesn’t follow the science.”

The complaint against Alabama Medicaid builds on CHLPI’s successful policy advocacy and litigation campaigns to expand access to DAA treatments in state Medicaid programs across the country. Since 2017, 19 states have removed treatment restrictions based on drug or alcohol use.  But severe, illegal sobriety restrictions remain. Alabama, Mississippi, Arkansas, South Carolina, and South Dakota still require Medicaid enrollees who are sick with HCV to prove they have been abstinent from drugs or alcohol for six months before they can access lifesaving treatment, and Iowa, North Dakota, and West Virginia impose a similar three-month abstinence requirement. However, nationally recognized guidance published by the American Association for the Study of Liver Disease and the Infectious Diseases Society of America recommends DAA treatment for all patients with chronic HCV infection, regardless of drug or alcohol use.