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DOJ and HHS Issue Joint Letter to Ensure That State Medicaid Programs Provide Equal Access to Hepatitis Treatment for People with Substance Use Disorder

January 26, 2024
Source: Justice Department (DOJ)

The Justice Department announced today that it and the Department of Health and Human Services (HHS) issued a joint letter to state Medicaid administrators urging them to ensure, in accordance with the Americans with Disabilities Act (ADA), that their Medicaid programs allow people who have both Hepatitis C (HCV) and substance use disorder (SUD) to access life-saving HCV medications called direct-acting antivirals (DAAs). 

More than two million adults in the United States have HCV, which can result in a range of serious health conditions including liver disease, liver cancer and death. However, highly effective DAA medications cure HCV in more than 95% of cases.

“Medicaid recipients with substance use disorders are entitled to 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. “This letter reminds state Medicaid administrators that they have an obligation to ensure their programs are in compliance with federal civil rights law. The Justice Department stands ready to enforce the ADA in order to eliminate unnecessary barriers that stand in the way of equal access to health care.”

The letter highlights a settlement agreement between the Justice Department and Alabama’s Medicaid Agency (Alabama Medicaid) to address a policy that denied Medicaid coverage for DAAs to patients who had consumed any alcohol or illicit drugs within the six months prior to starting treatment. Alabama Medicaid’s policy meant that people with HCV and SUD, who also had evidence of recent use of alcohol and/or illicit drugs, were denied potentially life-saving medication. Following the initiation of an investigation by the department, Alabama Medicaid withdrew this policy and entered into an agreement to secure Medicaid coverage for such patients going forward.

The letter explains that both the Justice Department and HHS enforce the ADA with respect to state Medicaid programs. The ADA requires that states, in administering their Medicaid programs, provide individuals with disabilities, including SUD, equal opportunity to participate in and benefit from a state’s Medicaid program. The letter urges all state Medicaid administrators to review their current and forthcoming policies and practices, including those on HCV treatment, to determine if any changes are necessary to comply with the ADA.    

For more information on the Civil Rights Division, please visit For more information on the ADA, please call the department’s toll-free ADA Information Line at 800-514-0301 (TTY 833-610-1264) or visit ADA complaints may be filed online at

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