Alabama Medicaid discriminates against drug users, federal complaint says

Originally written by Amy Yurkanin and published on AL.com on May 11, 2022.

An Alabama Medicaid policy that requires hepatitis C patients to avoid drugs and alcohol for six months or lose access to lifesaving medication violates the Americans with Disabilities Act, according to a federal administrative complaint.

AIDS Alabama and the Harvard Center for Health Law and Policy Innovation filed the complaint Monday with the U.S. Department of Justice. The Americans with Disabilities Act protects people who use drugs from discrimination in medical care.

The Alabama Medicaid Agency covers the cost of prescription medication for people in the program, including several FDA-approved treatments for hepatitis C. The program requires patients to prove they have not used drugs or alcohol in the last six months, which prevents people who use substances from getting treatment for the virus.

Alabama is one of five states with six-month sobriety requirements, including Arkansas, Mississippi, South Carolina and South Dakota. Since 2017, 17 states have dropped similar requirements.

“Alabama’s health outcomes always seem to be among the worst in the nation,” said Kathie Hiers, CEO of AIDS Alabama, in a press release. “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.”

Sobriety requirements go against treatment guidelines from medical organizations such as the American Association for the Study of Liver Disease and the Infectious Diseases Society of America, according to the complaint. Studies cited in the complaint found that drug and alcohol users benefited from medications used to eliminate the hepatitis C virus.

A spokesman for the Alabama Medicaid Agency did not respond to a request for comment.

Hepatitis C spreads through contact with an infected individual’s blood. People who received blood transfusions or organ transplants before 1992 and injection drug users are at high risk for infection.

The number of people with hepatitis C increased rapidly between 2005 and 2017, driven in part by increases in opioid use. Many people infected with the virus have no symptoms, but others can suffer from liver scarring, cancer and even death. Medications that eliminate the virus are medically necessary for all who test positive, regardless of drug use, the complaint alleges.

“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, Harvard Center for Health Law and Policy Innovation Litigation Director, in a press release. “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.”