Less Than 25 Percent of Medicaid Beneficiaries With Hepatitis C Received Treatment Within 6 Months

Why OIG Did This Review

• More than 2 million Americans have hepatitis C. Thousands die from the disease each year despite the availability of oral medications that can cure hepatitis C with a simple, short course of treatment.
• Hepatitis C treatment is crucial to reducing morbidity and mortality and to achieving HHS’s goal of eliminating hepatitis C as a public health threat in the United States by 2030.
• Timely treatment can also generate significant savings for Federal health care programs by preventing costly complications from untreated infection.
• Medicaid is one of the largest insurers of people with hepatitis C, underscoring the program’s key role in ensuring access to treatment. Dual-eligible beneficiaries (i.e., those enrolled in both Medicaid and Medicare) would primarily receive treatment for hepatitis C through Medicare rather than Medicaid.

What OIG Found

• Only 23 percent of Medicaid beneficiaries with hepatitis C received treatment within 6 months of testing.
• For those treated within 6 months, treatment typically took 7 weeks to start—despite recommendations to treat immediately.
• Among individual States, the rate of beneficiaries treated within 6 months ranged from 7 percent to 41 percent.
• Treatment rates were lower among certain populations, including newly infected beneficiaries, dual-eligible beneficiaries, older adults, and children.

What OIG Recommends

OIG recommends that CMS:

1. Take additional steps to increase hepatitis C treatment rates in Medicaid, building on data collected through the Medicaid hepatitis C quality measure starting in 2027.
2. Take targeted steps to increase hepatitis C treatment rates among dual-eligible beneficiaries who receive treatment primarily through Medicare.

CMS concurred with our recommendations.

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