As a liver disease doctor in Chicago, Illinois, Nancy Reau treats patients with hepatitis C, a viral infection that kills more people in the United States than 60 other infectious diseases combined, including HIV. Her practice has changed dramatically since 2013, when a flurry of miracle “cures” for hepatitis C were approved. Since then, Reau has successfully treated a majority of her hepatitis C-positive patients.
However, Reau still has about 30 patients who are waiting for treatment. These patients have one trait in common—they’re covered by Medicaid. Across the country, Medicaid programs continue to triage curative treatment, even as most other insurance providers have adopted a treat-all approach. Some Medicaid restrictions include sobriety tests and proof of extensive liver damage, which run counter to medical consensus.
Treatment denial “is a hard message for patients to stomach, especially a patient who has finally invested in taking care of themselves,” Raeu says. Often, she adds, “they fall out of the system.” For many state Medicaid programs, restricting access softens the financial blow of expensive hepatitis C cures. But for doctors, these restrictions are a nightmare, as they block access for their most vulnerable patients.