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Hep C Treatment for Patients on Medicaid

A look at some of the challenges people insured through Medicaid may face when seeking treatment for hep C.

Medically reviewed in May 2021

People with chronic hepatitis C are encouraged to seek treatment as soon as possible. A viral infection that causes inflammation in the liver, chronic hep C can result in cirrhosis, liver cancer, and liver failure. While it often takes years for this level of damage to occur, earlier treatment is associated with better outcomes among people with hep C—less liver damage, fewer complications, longer lifespans.

Unfortunately, people who seek treatment for hepatitis C may face a number of obstacles. The medications used to treat hepatitis C must be taken daily, usually for several months, and treatment cannot be paused once it begins. The medications used to treat hepatitis C—called direct-acting antivirals (DAAs)—can cause side effects. And the medications can be expensive.

People paying for treatment through an insurance provider—in other words, the vast majority of people being treated for hep C—may need to meet certain qualifications in order for their treatment to be approved.

Here we look at what people who are insured through Medicaid need to know about seeking treatment for hepatitis C.

About Medicaid
Before we get started on hep C treatment coverage under Medicaid, it’s helpful to understand the basics of Medicaid.

  • Medicaid is a public health insurance program that provides no-cost or low-cost health insurance to qualified Americans.
  • Medicaid provided coverage to more than 72 million Americans (as of November 2020). This includes individuals, families, children, people who are pregnant, seniors, and people with disabilities.
  • It is a partnership between the Federal government and state governments. This means what’s included under Medicaid coverage will vary from state to state. And people who are applying for Medicaid coverage will apply through their state.
  • Medicaid should not be confused with Medicare, which is a federal program that provides health insurance to people over the age of 65 and people with certain disabilities or health conditions.

Keep in mind that this is a simplified explanation—like any health insurance program, things get more complex when you look at the details.

Does Medicaid cover hep C treatment?
Hepatitis C treatment is covered by Medicaid. However, who qualifies for treatment can be a bit complicated, and varies between different states.

  • There are a variety of hep C medications available, but only some medications may be covered under certain Medicaid plans.
  • Some state Medicaid plans only cover hep C treatment when medications are prescribed by specialists (such as a hepatologist, gastroenterologist, or infectious disease specialist).
  • Some state Medicaid plans only cover treatment for hep C when a person has progressive liver damage.
  • Some state Medicaid plans require abstinence from drugs and/or alcohol for a certain period of time in order to qualify for hep C treatment.

It is worth noting that such practices are seen as discriminatory by the medical community and that many people in law, government, and medicine are working to change these policies. It is also worth noting that much progress has been made in improving access to hep C treatment for people on Medicaid.

Hepatitis C treatment has been shown to be effective in people who use drugs and people with a history of substance use. These policies highlight another issue faced by people with hepatitis C—stigma.

Getting treatment for hep C
The first step to getting treatment for hep C is working with a healthcare provider. Hep C treatment is different for every person. A healthcare provider can advise you on what tests you need, what medications they recommend, and how long treatment can last. They can also advise you on protecting the health of your liver.

You may also need to check your state’s eligibility requirements for hep C treatment. If you need to contact Medicaid, watch our video on 6 Things Hep C Patients Need When Calling an Insurance Company. And if coverage is denied and you need to appeal, read What to Do When Hepatitis C Treatment is Denied.

Remember, while treatment for hep C can take some legwork, treating hepatitis C is worth the time and effort. The medications used to treat hepatitis C cure roughly 95 percent of chronic infections. Curing an infection will help prevent further damage to the liver and long-term complications.

Medically reviewed in May 2021.

Sources:
Elsevier Point of Care. "Clinical Overview: Hepatitis C."
Mayo Clinic. "Hepatitis C."
NHS inform. "Hepatitis C."
Marjan Javanbakht, Roxanne Archer, Jeffrey Klausner. "Will prior health insurance authorization for medications continue to hinder hepatitis C treatment delivery in the United States? Perspectives from hepatitis C treatment providers in a large urban healthcare system." PLoS ONE. Novemeber 4, 2020.
Nick Voyles. "We can’t eliminate hepatitis C without removing barriers to treatment."  STAT. November 13, 2020.
Mayo Clinic. "Coping with side effects of hepatitis C drugs."
UpToDate. "Patient education: Hepatitis C (Beyond the Basics)."
State of Hep C. "Discriminatory State Medicaid Restrictions."
Medicaid.gov. "Eligibility."
Medicaid.gov. "November 2020 Medicaid & CHIP Enrollment Data Highlights."
Robin Rudowitz, Rachel Garfield, and Elizabeth Hinton. "10 Things to Know about Medicaid: Setting the Facts Straight." Kaiser Family Foundation. March 06, 2019.
State of Hep C. "Hepatitis C: The State of Medicaid Access May 2021 National Progress Report."
American Society of Addiction Medicine. "Hepatitis C Infection."
ScienceDaily. "Highly curative hep C treatment safe, effective for drug users." American College of Physicians. August 9, 2016.
Maria A. Corcorran. "Making a Decision on When to Initiate HCV Therapy." Hepatitis C Online. April 19, 2021.
U.S. Department of Veterans Affairs. "Hepatitis C medications: An overview for patients."
U.S. Food & Drug Administration. "Hepatitis C Treatments Give Patients More Options."

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