In January, the Departments of Justice (DOJ) and Health and Human Services issued a joint letter (PDF, 149KB) to state Medicaid administrators urging them to ensure that their Medicaid programs allow people with hepatitis C virus (HCV) and substance use disorder (SUD) to access curative HCV medications, known as direct-acting antiretrovirals (DAAs). The letter, signed by Kristen Clarke, Assistant Attorney General for Civil Rights, DOJ, and Chiquita Brooks-LaSure, Administrator, Centers for Medicare and Medicaid Services (CMS), reminds states that the Americans with Disabilities Act (ADA) requires state Medicaid programs to not discriminate against individuals with disabilities, including SUD.

Assistant Attorney General Clarke said in a press release, “Medicaid recipients with substance use disorders are entitled to the same access as others to a cure for Hepatitis C. This letter reminds state Medicaid administrators that they have an obligation to ensure their programs are in compliance with federal civil rights law. The Justice Department stands ready to enforce the ADA to eliminate unnecessary barriers that stand in the way of equal access to health care.”

The letter highlights a settlement agreement between DOJ and Alabama’s Medicaid Agency to address a policy that denied Medicaid coverage for DAAs to patients who had consumed any alcohol or illicit drugs within the six months prior to starting treatment.

HIV, HCV, and SUD can be co-occurring conditions and are part of a syndemic, or the clustering and interaction of two or more diseases, impacted by social and structural determinants of health, which leads to excess burden of disease in a population. According to data from the Centers for Disease Control and Prevention (CDC), an estimated 2.4 million people in the U.S. have HCV. An estimated 21% of people with HIV in the U.S. also have HCV. In 2021, 57% of acute hepatitis C cases with risk information reported injection drug use. Both the National HIV/AIDS Strategy and the Viral Hepatitis National Strategic Plan (PDF, 1.68MB) prioritize addressing the epidemics and substance use with a syndemic approach, integrating prevention and care programs and breaking down silos in approaches to these epidemics.