Alabama Medicaid Removes HCV Treatment Access Restrictions Following Complaint from Harvard Center for Health Law and Policy Innovation

Alabamians with substance use disorder and Medicaid coverage can now access curative HCV treatment.

Effective October 1, 2022, Alabama Medicaid announced that it is removing sobriety-related restrictions to lifesaving Hepatitis C (HCV) treatment. The policy change was made just months after the Center for Health Law and Policy Innovation (CHLPI) and AIDS Alabama filed an administrative complaint with the U.S. Department of Justice, alleging that Alabama’s Medicaid program was illegally denying HCV treatment to people with substance use disorder.

“AIDS Alabama and other health care providers are very excited to learn that Alabama Medicaid has removed unnecessary sobriety criteria that would keep persons with hepatitis C from accessing the cure,” said Kathie Hiers, CEO for AIDS Alabama.  “As an agency that assists many people living with HIV, we see extremely high rates of coinfection.  Now our patients can treat and cure their hep C and then focus on staying healthy with HIV.  Alabama Medicaid should be commended for this step forward in helping to improve the health of Alabamians.”

“We are thrilled that Alabama Medicaid has decided to remove this discriminatory barrier to HCV treatment for people with substance use disorder,” said Kevin Costello, Litigation Director for CHLPI. “It is not only illegal to deny a person critical HCV care based on substance use, but it is squarely outside of the standard practice of care. DAA treatments are recommended for all patients with chronic HCV infection, regardless of drug or alcohol use, and they are our best tool in eliminating the spread of this deadly disease.”

HCV is curable, yet it 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, many state Medicaid programs restrict access to DAAs. Only one in four Medicaid recipients diagnosed with HCV will receive timely treatment.

Alabama Medicaid’s previous policy denied treatment to people with HCV if they used illicit drugs or alcohol in the past six months, and it required patients to maintain sobriety throughout the course of treatment or risk losing coverage. CHLPI and AIDS Alabama argued that these restrictions violated the Americans with Disabilities Act, which protects people who are disabled due to substance use disorder. Effective, October 1, 2022, Alabama Medicaid will no longer require sobriety in order to cover the cost of HCV treatment for patients.

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, 21 states have completely removed treatment restrictions based on drug or alcohol use.  But, 16 states still impose restrictions to HCV treatment based on patient substance use, with 10 states requiring strict abstinence prior to or during treatment. “Removing these barriers is a health equity issue, and we are committed to expanding our enforcement campaign to states where sobriety restrictions persist,” said Costello.