Medicaid Policy and Hepatitis C Treatment Among Rural People Who Use Drugs

Area of Science:

• Public Health
• Infectious Diseases
• Health Policy

Background:

• Restrictive Medicaid policies for hepatitis C virus (HCV) treatment may worsen rural health disparities for people who use drugs (PWUD).
• This study assessed the association between state-level Medicaid treatment restrictions and HCV treatment initiation and cure among rural PWUD.

Purpose of the Study:

• To evaluate how Medicaid policies restricting HCV treatment impact treatment rates and cure among rural PWUD.
• To determine if specific policy restrictions (prescriber type, sobriety, fibrosis) influence HCV treatment outcomes.

Main Methods:

• Cross-sectional, ecological analysis of state-specific Medicaid policies in 8 rural US sites across 10 states.
• Merged policy data with participant survey data from 944 PWUD; used bivariate and logistic regression analyses to assess associations between restrictions and HCV treatment outcomes.

Main Results:

• 111 (12%) participants received HCV treatment; those treated were older, more likely to receive disability support, and less likely to be Medicaid-insured.
• PWUD in states without restrictions had higher rates of treatment initiation (17% vs. 11%) and HCV cure (42% vs. 30%) compared to those in states with restrictions.
• Medicaid restrictions were associated with lower odds of HCV treatment receipt (OR=0.61) and cure (OR=0.60).

Conclusions:

• Significant associations exist between Medicaid restrictions and lower HCV treatment and cure rates among rural PWUD.
• Removing remaining state-level Medicaid restrictions is essential for achieving hepatitis C virus elimination goals.
• Addressing policy barriers is critical to reducing health disparities in HCV care for vulnerable populations.