Alabama agrees to drop Medicaid sobriety rule for antiviral medications

(CN) — In violation of the Americans with Disabilities Act, the Alabama Medicaid Agency routinely denied coverage of medications for Hepatitis C patients who also showed symptoms of substance abuse disorder, according to a settlement agreement with the Department of Justice announced Monday.

U.S. Attorney Prim F. Escalona for the Northern District of Alabama said the restriction prevented many Alabamians from receiving appropriate treatment and the settlement “significantly advances public health in our state.”

The DOJ contends the state agency’s so-called “sobriety restriction” was not based on acceptable standards of medical care and discriminated against patients struggling with substance abuse problems, preventing equal access to health care. The restriction “withheld a potentially life-saving service” from an unspecified number of patients during the unspecified term of its practice, according to a news release and the accompanying settlement agreement. 

Specifically, the state’s policy was “a blanket sobriety restriction denying access to potentially life-saving direct acting antiviral agents (DAA) to applicants who used alcohol or illicit drugs at any time during a six-month window prior to treatment, and non-payment for DAA treatment for Medicaid recipients who are found to have used alcohol or illicit drugs during the course of their treatment.”

The agency disagreed with the DOJ’s determination and denied any wrongdoing, but voluntarily cooperated with the investigation and has agreed to revise related policies to comply with Title II of the ADA. 

According to a statement from Alabama Medicaid Commissioner Stephanie Azar, "the Alabama Medicaid Agency cooperated fully with the Department of Justice to respond to the complaint received. Alabama Medicaid denies that the Agency violated Title II of the ADA.  As indicated by the agreement, the Agency removed any sobriety policy related to Hepatitis C (HCV) treatment effective October 1, 2022.  The agreement further demonstrates the Agency’s desire for successful HCV treatment within the Medicaid population."

Hepatitis C is a viral infection — most often transmitted by the sharing of needles or syringes but also through birth, sexual contact and other means — that targets the liver and can become a chronic condition in some patients. Although there is not a vaccine to prevent its transmission, Hepatitis C can be treated and cured with antiviral medications, which are successful in more than 95% of cases. The medications can also prevent the spread of Hepatitis C to others.

“Abstaining from alcohol or illicit drugs is not medically required for this successful outcome,” the DOJ noted. 

Effective Oct. 1, 2022, the Alabama Medicaid Agency will no longer “delay, deny, or fail to pay for [antiviral] treatment of [Hepatitis C] based on any Medicaid recipient’s use of drugs or alcohol,” the agreement states, while it will also “take any and all additional steps necessary to effectuate its withdrawal of the sobriety policy” and prohibit new restrictions related to drug or alcohol use, “such as requiring drug or alcohol treatment or counseling.”

According to the Centers for Disease Control and Prevention, Alabama reported 5,697 new cases of chronic Hepatitis C in 2020, one of the highest per-capita rates in the nation with 115 cases per 100,000 people. Only West Virginia had a higher rate, with 122 cases per 100,000 residents. Data for four states was unavailable.

The Alabama Medicaid Agency did not immediately respond to a request for comment.

“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.

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