Description: The Justice Department secured a settlement agreement with the state of Alabama’s Medicaid Agency (Alabama Medicaid) under the Americans with Disabilities Act (ADA) to ensure that Alabama Medicaid recipients with Hepatitis C (HCV) who also have a substance use disorder have equal access to medications to treat their hepatitis.
Alabama Medicaid previously maintained a longstanding sobriety restriction policy that denied coverage of HCV medication for any person with HCV who had consumed any alcohol or illicit drugs within the six months prior to starting treatment. The sobriety restriction policy also barred Medicaid payment for HCV medication if a person used alcohol or illicit drugs while using the medication.
“Alabama Medicaid’s reversal of its longstanding sobriety restriction will finally allow Medicaid recipients with substance use disorders to have the same access as others to a cure for Hepatitis C,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “The Justice Department is committed to enforcing the Americans with Disabilities Act to eliminate unnecessary barriers that stand in the way of equal access to health care.”
“We appreciate Alabama Medicaid’s willingness to work with the Department of Justice and our office to remove the sobriety restriction policy that prevented so many Alabamians with HCV, who also have substance use disorder, from receiving appropriate treatment,” said U.S. Attorney Prim F. Escalona for the Northern District of Alabama. “This settlement agreement delivers justice under the Americans with Disabilities Act and significantly advances public health in our state.”
HCV can result in a range of serious health conditions, many of which affect the liver. These may include cirrhosis, liver cancer, liver failure and death. However, according to the Centers for Disease Control and Prevention, highly effective treatments called direct-acting antiviral medications (DAAs) cure HCV in more than 95% of cases. In addition, use of these medications can also stop the spread of HCV because treated individuals will not transmit HCV to others. Abstaining from alcohol or illicit drugs is not medically required for this successful outcome. Alabama Medicaid’s sobriety restriction policy withheld a potentially life-saving service to individuals with HCV who also had (or who were regarded as having, and/or who had a record of) a substance use disorder.
Alabama Medicaid worked cooperatively to modify its policies to ensure that Medicaid recipients have access to DAA treatment for HCV without regard to an individual’s substance use. Alabama Medicaid has withdrawn the sobriety restriction policy, and under today’s settlement will not delay, deny or fail to pay for DAA treatment of HCV based on any Medicaid recipient’s use of drugs or alcohol. Further, it will engage in a robust effort to notify Medicaid recipients and Medicaid providers of these changes, as well as promptly remedy any instances where the prior policy is applied.