Hepatitis C Medicaid Affinity Group: Supporting State-Generated Solutions to Eliminating HCV
The Hepatitis C Medicaid Affinity Group (Affinity Group) was created to improve health outcomes for people with chronic hepatitis C infection who are enrolled in state Medicaid programs by increasing the number and percentage of Medicaid patients diagnosed with hepatitis C virus (HCV) infection who are successfully treated and cured.
The efforts of the Affinity Group are driven by state teams made up of representatives from state Medicaid agencies, public health departments, and other programs such as those that address behavioral health care and substance use disorders.
|State||Total # of People Living with Anti-HCV||Total # of People with Medicaid|
|New York (NY)||223,700||6,089,989|
The CDC estimates that approximately 3.5 million people in the United States are living with HCV infection.
A recent analysis found that HCV infection leads to more than 2.3 million outpatient medical visits and over 73,000 emergency room visits annually, as well as a total of 2.8 million days of inpatient care. The cost of inpatient visits for one year was more than $15 billion. A disproportionate number of patients with HCV infection receive public insurance, including Medicaid. Increasing access to screening, diagnosis and early HCV treatment for Medicaid patients can make a significant contribution toward saving lives, reducing new infections, controlling health care costs, and ultimately eliminating viral hepatitis, all goals described in the National Viral Hepatitis Action Plan (Action Plan)
New HCV treatments can result in a cure for approximately 95% of people who take them. People who are cured of their HCV experience multiple health benefits and are significantly less likely to develop severe liver disease, liver cancer, and liver failure, which can be very costly conditions. However, many states have experienced challenges in providing HCV treatment for patients with Medicaid and other public insurance. More intensive efforts are needed and model programs must be replicated to increase screening and diagnosis, ensure follow up care, manage the costs of treatment, and raise provider and public awareness about HCV risks and new treatments that offer a strong chance of a cure.
States are the key leaders in public health innovation, but do not always have opportunities to share effective strategies and collaborate to identify solutions to common challenges. The Affinity Group addresses this need by bringing states together to support the development and implementation of innovative strategies for scaling up HCV treatment.
The Affinity Group is a continuous quality improvement project that will support the development of evidence-based practices and implementation strategies to improve Medicaid systems’ efforts to address HCV. It will be evaluated to identify the most effective and acceptable activities for states and to inform future efforts. The project aims to:
- Foster state collaboration and the sharing of promising practices;
- Develop and implement innovative HCV-related policies and programs;
- Increase the number and percentage of Medicaid beneficiaries diagnosed and successfully treated (or cured) for HCV.
For more information on benefits of participating in the Affinity Group, watch a recorded introductory webinar.
Convened by the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) in the Office of the Assistant Secretary for Health, the Affinity Group is a collaborative effort across HHS that also engages the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the HHS Office of Minority Health (OMH), and the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide technical assistance and consultation to participating states.
Example of Hepatitis C Medicaid Affinity Group activities undertaken by states include:
- Calculating the HCV care cascade, leveraging work conducted by the HIV Affinity Group: States have developed data use agreements between state Medicaid programs and public health agencies to share data on HCV screening, diagnosis, and treatment. By calculating care cascades, states aim to identify screening and treatment patterns and develop targeted approaches to improve access. Populations of interest include individuals co-infected with HIV, people who inject drugs, women, and infants born to women with HCV.
- Enhancing provider knowledge of HCV testing and treatment: States have developed new curricula and trained providers on HCV treatment. States are also increasing provider capacity to treat people for HCV through Project ECHO, a tele-mentoring program. Finally, they are analyzing data to identify high burden areas and prescribing patterns to inform provider capacity-building efforts.
- Assessing and revising prior authorization processes for HCV medication. States are assessing the financial and clinical impact of lifting Medicaid restrictions on HCV medications. At least one state removed prescriber specialty requirements and modified criteria related to substance use.
- Improving treatment for people who inject drugs: States are exploring opportunities to co-locate HCV screening and treatment with treatment for substance use disorder. At least one state has offered HCV screening at harm reduction sites.
Affinity Group state participants met with federal partners and other subject matter experts in Washington DC on February 8-9, 2018. The primary goal of the in-person convening was to help states obtain and share information to advance their goal of increasing the number of people cured of HCV. Links to some of the convening’s presentations are below.
Viral Hepatitis: We Can Eliminate Hepatitis C, Update on the Most Recent AASLD Recommendations. Bruce Luxon (MD, PhD) from the American Association for the Study of Liver Diseases (AASLD) and Georgetown University presented the latest AASLD treatment guideline: “Treatment is recommended for all patients with chronic HCV infection, except those with short life expectancies that cannot be remediated by treating HCV...” He also described the progression of liver disease with HCV, changes in cure rates with medication advances, and the cost effectiveness of treatment.
Hepatitis C: The State of Medicaid Access, 2017 National Summary Report. Elizabeth Paukstis (MA, JD) summarized findings of a study conducted by the National Viral Hepatitis Roundtable on the status of Medicaid reimbursement criteria for direct acting antiviral drugs (DAAs). While more states are eliminating/reducing restrictions related to severity of illness and prescriber qualifications, many have maintained sobriety restrictions.
Prior Authorization of Hepatitis C Medications in NYS Medicaid Fee for Service (FFS) and Medicaid Managed Care. Monica Toohey (RPh) from the New York State Department of Health described the state’s Drug Utilization Review process and timeline to first implement and then lift DAA reimbursement criteria. To streamline DAA prior authorization, the state relies on automation and encourages managed care organizations to use standardized criteria and processes.
Reframing Reinfection: Public Health Strategies for the Era of Hepatitis C Elimination. Daniel Raymond from the Harm Reduction Coalition described why it is importance to treat people with injection drug use of HCV despite risk of re-infection. He also recommended strategies for preventing re-infections.
The Affinity Group meets monthly to discuss HCV-related strategies with subject matter experts. Links to some of the presentations from these monthly calls are below.
HCV Testing and Treatment in the Corrections Context: Mandy Altman (MPA, CCHP) from the Hepatitis Education Project presented in March. She discussed barriers and opportunities to treating incarcerated populations for HCV, including how prisons purchase medications.
HCV Medication Prior Authorization: Paulina Deming (PharmD) from the University of New Mexico presented in May on strategies for addressing Medicaid and other insurers’ prior authorization requirements for HCV medications and the role of pharmacist clinicians in HCV care.
Project ECHO and HCV Treatment: Greg Howe from the Center for Health Care Strategies presented in June on state Medicaid financing models for Project ECHO and other potential financing mechanisms.
Treating People Who Inject Drugs (PWID) for HCV: Lynn E. Taylor (MD, FACP, FAASLD) from the University of Rhode Island and Director of HIV and Viral Hepatitis Services, CODAC Behavioral Health presented in July on the rationale for and benefits of treating HCV in people who inject drugs and discussed facilitators of HCV cure among PWID.
How States Use Medicaid and State Health Department Data to Improve Health Outcomes of People Living with HIV (National Academy for State Health Policy, NASHP)
MassHealth Value-Based Pharmacy Purchasing Proposal (MassHealth)
Medicaid Financing Models for Project ECHO (Center for Health Care Strategies, Inc.)
Reducing Substance Use Disorders – Technical Support for Medicaid Agencies Opioid Data Analytics Cohort & Additional Opportunities (Medicaid Innovation Accelerator Program)
Webinar - Hepatitis C: The State of Medicaid Access (National Viral Hepatitis Roundtable)