Since 2014, The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) and the National Viral Hepatitis Roundtable (NVHR) have fought to ensure that all people living with hepatitis C (HCV) are able to access treatment through our joint work on the Hepatitis C: State of Medicaid Access project.
We’re pleased to report our collective advocacy over the last decade has been working. In particular, the ongoing publication of our State of Medicaid Access reports has successfully supported efforts to eliminate treatment restrictions across the nation. Since we began publishing annual reports in 2017, 21 states have removed prior authorization requirement for most patients, 33 have either eliminated or reduced their fibrosis restrictions, 36 have loosened their sobriety restrictions, and 35 have scaled back their prescriber restrictions.
We celebrate this significant wave of progress, but our work will not be done until the promise of an HCV cure is an accessible reality for all. It is in that spirit that we bring you our 2023 snapshot of Medicaid access. You can click of the categories below to jump to that topic or simply scroll to take it all in.
Overall Grades
A+ (9): Colorado, Idaho, Michigan, Missouri, Oklahoma, Rhode Island, Virginia, Washington, Wisconsin
A (12): Alaska, California, DC, Hawaii, Indiana, Louisiana, Massachusetts, New Hampshire, New York, Oregon, Pennsylvania, Texas,
B (11): Alabama, Arizona, Connecticut, Kansas, Kentucky, Minnesota, Mississippi, North Carolina, Tennessee, Utah, Vermont
C (12): Florida, Georgia, Maine, Maryland, Montana, Nevada, New Jersey, New Mexico, Ohio, Puerto Rico, West Virginia, Wyoming
D (6): Delaware, Iowa, Nebraska, North Dakota, South Carolina, South Dakota
F (2): Arkansas, Illinois
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Prior Authorization Requirements
No Prior Authorization for Most Patients (21): Alaska, Arizona, California, Colorado, DC, Hawaii, Idaho, Indiana, Louisiana, Massachusetts, Michigan, Missouri, New Hampshire, New York, Oklahoma, Oregon, Rhode Island, Texas, Virginia, Washington, Wisconsin
Prior Authorization Required (31): Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Pennsylvania, Puerto Rico, South Carolina, South Dakota, Tennessee, Utah, Vermont, West Virginia, Wyoming
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Fibrosis Restrictions
No Fibrosis Restrictions (50): Alabama, Alaska, Arizona, California, Colorado, Connecticut, DC, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Fibrosis Restrictions (2): Arkansas, South Dakota
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Sobriety Restrictions
No Substance Use Restriction (38): Alabama, Arizona, California, Colorado, Connecticut, DC, Florida, Georgia, Hawaii, Idaho, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wyoming
Provider Must Address and/or Counsel Patient About Substance Use Issues Prior to Treatment (8): Alaska, Illinois, Iowa, Minnesota, Mississippi, Montana, West Virginia, Wisconsin
Substance Use Restriction Prior to or During Treatment, Including Abstinence and Mandatory SUD Treatment (6): Arkansas, Delaware, Nebraska, North Dakota, South Carolina, South Dakota
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Prescriber Restrictions
No Prescriber Restrictions (46): Alabama, Alaska, Arizona, California, Colorado, Connecticut, DC, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Louisiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Prescription by or in Consultation with a Specialist (6): Arkansas, Illinois, Iowa, Nevada, Puerto Rico, South Carolina
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Retreatment Restrictions
No Retreatment Restrictions (32): Alaska, Colorado Connecticut, DC, Hawaii, Idaho, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin
Retreatment Restrictions based on adherence, substance use, or SVR12 documentation (20): Alabama, Arizona, Arkansas, California, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Maine, Montana, Nebraska, New York, North Dakota, Ohio, West Virginia, Wyoming
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Managed Care Restrictions
No Additional Restrictions in Managed Care (25): Arkansas, Colorado, Florida, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Montana, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Virginia, Washington
Additional Restrictions and/or Lack of Transparency in Managed Care (16): Arizona, DC, Delaware, Georgia, Hawaii, Illinois, Maryland, Massachusetts, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Texas, Utah
N/A, State Doesn’t Contract with Managed Care (11): Alabama, Alaska, California, Connecticut, Idaho, Indiana, Maine, Vermont, West Virginia, Wisconsin, Wyoming
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Compare this snapshot
with our previous updates: