Programs and Initiatives

The Office of Infectious Disease and HIV/AIDS Policy Viral Hepatitis team leads numerous programs and initiatives aimed at reaching viral hepatitis elimination goals outlined in the Viral Hepatitis National Strategic Plan.

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Hepatitis C Medicaid Affinity Group: Supporting State-Generated Solutions to Eliminating HCV

The Hepatitis C Medicaid Affinity Group (Affinity Group) aims to increase the number and percentage of Medicaid beneficiaries diagnosed with hepatitis C virus (HCV) who are successfully treated and cured.

It provides support to states to develop and implement their own initiatives, provide information and technical assistance, and explore strategies related to HCV in specific settings, such as correctional and behavioral health.

Many of the resources, state strategies, and other information is available through the links below.

Participating States

The efforts of the Affinity Group are driven by state teams made up of representatives from state Medicaid agencies, public health departments, correctional agencies, and other programs, such as those that address behavioral health care and substance use disorders.

Nineteen jurisdictions in total participated in the Affinity Group, including Los Angeles County and Washington, DC. Multiple states participated for more than one year, as demonstrated by the asterisks in the below map.

US Map

Year 3 State Participants: Arkansas, Idaho, *Indiana, *Kentucky, *Michigan, New Hampshire, *Washington, West Virginia, and *Wisconsin
Previous Year State Participants: Alaska, District of Columbia, Los Angeles County, Louisiana, Maryland, Massachusetts, New York State, Tennessee, Vermont, and Virginia

New HCV treatments can result in a cure for approximately 95% of people who take them. People who are cured of HCV experience multiple health benefits and are significantly less likely to develop severe liver disease, liver cancer, and liver failure, which are often very costly conditions. Eliminating hepatitis requires increasing access to screening, diagnosis, and early HCV treatment, which together will save lives, reduce new infections, and control health care costs. These goals are described in the The Viral Hepatitis National Strategic Plan: A Roadmap to Elimination 2021-2025.

States are key leaders in public health innovation, but do not always have opportunities to share effective strategies and collaborate to identify solutions to common challenges. The Affinity Group addressed this need by bringing states together to support developing and implementing innovative strategies for scaling up HCV screening, treatment, and cure.

The Affinity Group was a continuous quality improvement project that supported the development of evidence-based practices and implementation strategies to improve Medicaid systems’ efforts to address HCV. The project aimed to:

  1. Foster state collaboration and share promising practices;
  2. Develop and implement innovative HCV-related policies and programs;
  3. Increase the number and percentage of Medicaid beneficiaries diagnosed and successfully treated (or cured) for HCV.

Convened by the Office of Infectious Disease and HIV/AIDS Policy (OIDP) in the Office of the Assistant Secretary for Health (OASH), the Affinity Group was a collaborative effort across the Department of Health and Human Services (HHS). It also engaged Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), and Substance Abuse and Mental Health Services Administration (SAMHSA) to provide technical assistance and consultation to participating states.

Example of Affinity Group activities undertaken by states include:

  • Using data to inform policy decisions: Leveraging work conducted by the HIV Affinity Group, states developed data use agreements between state Medicaid programs, public health agencies, and corrections departments to share data on HCV screening, diagnosis, and treatment. By calculating care cascades, states aimed to identify screening and treatment patterns and develop targeted approaches to improve access. Populations of interest included individuals co-infected with HIV, people who inject drugs, women, and infants born to women with HCV.
  • Making direct-acting antivirals (DAAs) more affordable: States are addressing the high cost of HCV treatment by developing innovative payment arrangements including subscription payment models and 340B pricing for covered entities.
  • Removing structural barriers to DAAs: Multiple states removed fibrosis score restrictions, prescriber specialty requirements, and restrictions related to substance use. States also streamlined or removed Medicaid prior authorization requirements.
  • Enhancing provider capacity for HCV testing and treatment: States developed new curricula, trained providers, and implemented pharmacist-led treatment models. States also increased provider capacity through Project ECHO, a tele-mentoring program. In addition, they analyzed data to identify high-burden areas and prescriber patterns to inform provider capacity-building efforts.
  • Increasing treatment access for people who inject drugs and in correctional settings: States are exploring opportunities to co-locate HCV screening and treatment with treatment for substance use disorder. In addition, several participants increased screening and treatment rates of inmates and improved care coordination efforts so individuals can enroll into Medicaid and continue or start HCV treatment upon release from incarceration.

The Affinity Group prepares technical assistance documents and resources to assist states in implementing their HCV strategies. In addition, the Affinity Group conducts an evaluation at the end of each year to assess whether states achieved their goals, whether states reported strong engagement and satisfaction with Affinity Group activities, and whether the Affinity Group helped advance state activities and improve collaboration across state entities. Resources developed under the Affinity Group include:

Technical Assistance Documents
Evaluations
  • Hepatitis C Medicaid Affinity Final Report. Summary of the evaluation findings validating successful strategies to eliminate hepatitis C. The report covers proven state-level strategies for: hepatitis C screening, linkage to care, and treatment; successes and challenges for state strategy implementation; affinity group support of state strategies; and recommendations for states and HHS to continue to promote access to hepatitis C treatment.
  • Hepatitis C Medicaid Affinity Group: Evaluation Summary 2018-2019. Evaluation summary outlining key findings from the Year 1 and Year 2 Affinity Group evaluations, including state progress on goals, state engagement and satisfaction with the Affinity Group, collaboration successes and challenges, calculation of HCV outcomes measures, lessons learned, and considerations for future Affinity Groups
Case Studies

HCV Guidelines
Resources for Providers
Data Tools
  • Hep C State Policy Simulator – Created by Massachusetts General Hospital and Harvard Medical School; Funded by the CDC
  • Hepatitis C: State of Medicaid Access – National Viral Hepatitis Roundtable (NVHR) and Center for Health Law and Policy Innovation, Harvard Law School
  • Hep C Calculator – Created by Rollins School of Public Health, Massachusetts General Hospital and Harvard Medical School; Supported by the World Health Organization and UNITAID
  • HepCorrections – Created by Massachusetts General Hospital and Harvard Medical School; Funded by the National Science Foundation
  • MappingHepC.com – AbbVie Inc.
Payment Models
Other Resources for State Agencies

The Affinity Group hosts monthly webinars on HCV-related topics to help states advance their activities. In addition, annual in-person convenings provide a platform for states to learn about challenges and successful approaches in other states and to engage with subject matter experts. Presentation slides are grouped below by major topic.

General HCV
Using Data to Inform Policy Decisions
Making DAAs More Affordable
Removing Structural Barriers to DAAs
  • Managed Care and HCV Treatment Access (2019).. Importance of state monitoring of DAA restriction parity between Medicaid fee-for-service and managed care. Lauren Canary (MPH), National Viral Hepatitis Roundtable
  • HCV Elimination by 2030 (2019). Barriers to HCV treatment in the U.S., progress made in removing restrictions from 2014 to 2019, and what can be done moving forward to achieve HCV elimination. Michael Ninburg (MPA), Hepatitis Education Project
  • Liberalization of Coverage for DAAs in Wisconsin (2019). Policy changes made to remove DAA restrictions and post-policy utilization and fiscal impact in the state of Wisconsin. Julie Sager (MD), Wisconsin Division of Medicaid Services
  • Prior Authorization of Hepatitis C Medications in NYS Medicaid Fee for Service (FFS) and Medicaid Managed Care. Monica Toohey, RPh from the New York State Department of Health described the state’s Drug Utilization Review process and timeline to first implement and then lift DAA reimbursement criteria. To streamline DAA prior authorization, the state relies on automation and encourages managed care organizations to use standardized criteria and processes.
  • HCV Medication Prior Authorization (2018). Strategies for addressing Medicaid and other insurers’ prior authorization requirements for HCV medications and the role of pharmacist clinicians in HCV care. Paulina Deming (PharmD), University of New Mexico
Enhancing Provider Capacity for HCV Testing and Treatment
Correctional Settings
Injection Drug Use

*Content is undergoing 508 review and will be updated pending remediation. For immediate assistance, please contact: Jessica.Deerin@hhs.gov.

Content created by Office of Infectious Disease and HIV/AIDS Policy (OIDP)
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