Medicaid Policy and Hepatitis C Treatment Among Rural People Who Use Drugs

Thomas J. Stopka; Bridget M. Whitney; David De Gijsel; Daniel L. Brook; Peter D. Friedmann; Lynn E. Taylor; Judith Feinberg; April M. Young; Donna M. Evon; Megan Herink; Ryan Westergaard; Ruth Koepke; Jennifer R. Havens; William A. Zule; Joseph A. Delaney; Mai T. Pho

doi:10.1097/MLR.0000000000002095

Medicaid Policy and Hepatitis C Treatment Among Rural People Who Use Drugs

Thomas J. Stopka, Bridget M. Whitney, David De Gijsel, Daniel L. Brook, Peter D. Friedmann, Lynn E. Taylor, Judith Feinberg, April M. Young, Donna M. Evon, Megan Herink, Ryan Westergaard, Ruth Koepke, Jennifer R. Havens, William A. Zule, Joseph A. Delaney, Mai T. Pho

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background: Restrictive Medicaid policies regarding hepatitis C virus (HCV) treatment may exacerbate rural health care disparities for people who use drugs (PWUD). We assessed associations between Medicaid restrictions and HCV treatment among rural PWUD. Methods: We compiled state-specific Medicaid treatment policies across 8 US rural sites in 10 states and merged these with participant survey data. We hypothesized that local restrictions regarding prescriber type, sobriety, and fibrosis estimates were associated with HCV treatment outcomes. We conducted a cross-sectional, ecological analysis of treatment restrictions and HCV treatment outcomes using bivariate analyses to characterize differences between PWUD who initiated HCV treatment and unadjusted logistic regressions to assess associations between restrictions and treatment. Results: Among 944 participants, 111 (12%) reported receiving HCV treatment. Participants receiving treatment were older [median age (interquartile range): 42 (34-53) vs. 35 (29-42), P<0.001], more likely to receive disability support (32% vs. 20%, P=0.002), and less likely to be Medicaid-insured (57% vs. 71%, P < 0.001). More PWUD in states without any restrictions reported receiving treatment (17% vs. 11%, P=0.08) and achieving HCV cure/clearance (42% vs. 30%, P=0.01) than in states with restrictions. Restrictions were associated with lower odds of receiving HCV treatment (odds ratio=0.61, 95% CI: 0.35-1.06, P=0.08). Sensitivity analyses showed a similar association with HCV cure/clearance (odds ratio=0.60, 95% CI: 0.40-0.91, P=0.02). Conclusions: We identified significant unadjusted associations between Medicaid restrictions and receipt of HCV treatment and cure, which has substantial implications for health outcomes among rural PWUD. Lifting remaining Medicaid restrictions will be critical to achieving HCV elimination.

Original language	English
Pages (from-to)	77-88
Number of pages	12
Journal	Medical Care
Volume	63
Issue number	2
DOIs	https://doi.org/10.1097/MLR.0000000000002095
State	Published - Feb 1 2025

Bibliographical note

Publisher Copyright:
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Funding

The authors thank the other ROI investigators and teams, community and state partners, and the participants of the individual ROI studies for valuable contributions. In addition, the authors especially thank Dr Holly Hagan, our ex-officio steering committee chair, and Dr Richard Jenkins, our NIDA scientific research officer, for thoughtful guidance and leadership over the course of our multisite study. A full list of participating ROI institutions and other resources can be found at http://ruralopioidinitiative.org. Primary data collection was supported by grants UG3DA044829/ UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/ UH3DA044830, UG3DA044823/UH3DA044823, UH3DA044822/ UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by the National Institute on Drug Abuse (NIDA) with co-funding from the Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Appalachian Regional Commission (ARC). Research presented in this manuscript is the result of secondary data harmonization and analysis and was supported by grant U24DA048538 from NIDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, CDC, SAMHSA, the Department of Health and Human Services, or ARC. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UH3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825,UG3DA044826/UH3DA044826, and U24DA044801 co-funded by the National Institute on Drug Abuse (NIDA) with co-funding from the Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Appalachian Regional Commission (ARC). Research presented in this manuscript is the result of secondary data harmonization and analysis and was supported by grant U24DA048538 from NIDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, CDC, SAMHSA, the Department of Health and Human Services, or ARC.

Funders	Funder number
Centers for Disease Control and Prevention
Substance Abuse and Mental Health Services Administration
National Institutes of Health (NIH)
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse
U.S. Department of Health and Human Services
Appalachian Regional Commission	U24DA048538
Appalachian Regional Commission

Keywords

Medicaid policy
PWUD
direct acting antivirals
hepatitis C virus
rural

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1097/MLR.0000000000002095

Cite this

Stopka, T. J., Whitney, B. M., De Gijsel, D., Brook, D. L., Friedmann, P. D., Taylor, L. E., Feinberg, J., Young, A. M., Evon, D. M., Herink, M., Westergaard, R., Koepke, R., Havens, J. R., Zule, W. A., Delaney, J. A., & Pho, M. T. (2025). Medicaid Policy and Hepatitis C Treatment Among Rural People Who Use Drugs. Medical Care, 63(2), 77-88. https://doi.org/10.1097/MLR.0000000000002095

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title = "Medicaid Policy and Hepatitis C Treatment Among Rural People Who Use Drugs",

abstract = "Background: Restrictive Medicaid policies regarding hepatitis C virus (HCV) treatment may exacerbate rural health care disparities for people who use drugs (PWUD). We assessed associations between Medicaid restrictions and HCV treatment among rural PWUD. Methods: We compiled state-specific Medicaid treatment policies across 8 US rural sites in 10 states and merged these with participant survey data. We hypothesized that local restrictions regarding prescriber type, sobriety, and fibrosis estimates were associated with HCV treatment outcomes. We conducted a cross-sectional, ecological analysis of treatment restrictions and HCV treatment outcomes using bivariate analyses to characterize differences between PWUD who initiated HCV treatment and unadjusted logistic regressions to assess associations between restrictions and treatment. Results: Among 944 participants, 111 (12\%) reported receiving HCV treatment. Participants receiving treatment were older [median age (interquartile range): 42 (34-53) vs. 35 (29-42), P<0.001], more likely to receive disability support (32\% vs. 20\%, P=0.002), and less likely to be Medicaid-insured (57\% vs. 71\%, P < 0.001). More PWUD in states without any restrictions reported receiving treatment (17\% vs. 11\%, P=0.08) and achieving HCV cure/clearance (42\% vs. 30\%, P=0.01) than in states with restrictions. Restrictions were associated with lower odds of receiving HCV treatment (odds ratio=0.61, 95\% CI: 0.35-1.06, P=0.08). Sensitivity analyses showed a similar association with HCV cure/clearance (odds ratio=0.60, 95\% CI: 0.40-0.91, P=0.02). Conclusions: We identified significant unadjusted associations between Medicaid restrictions and receipt of HCV treatment and cure, which has substantial implications for health outcomes among rural PWUD. Lifting remaining Medicaid restrictions will be critical to achieving HCV elimination.",

keywords = "Medicaid policy, PWUD, direct acting antivirals, hepatitis C virus, rural",

author = "Stopka, \{Thomas J.\} and Whitney, \{Bridget M.\} and \{De Gijsel\}, David and Brook, \{Daniel L.\} and Friedmann, \{Peter D.\} and Taylor, \{Lynn E.\} and Judith Feinberg and Young, \{April M.\} and Evon, \{Donna M.\} and Megan Herink and Ryan Westergaard and Ruth Koepke and Havens, \{Jennifer R.\} and Zule, \{William A.\} and Delaney, \{Joseph A.\} and Pho, \{Mai T.\}",

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T1 - Medicaid Policy and Hepatitis C Treatment Among Rural People Who Use Drugs

AU - Stopka, Thomas J.

AU - Whitney, Bridget M.

AU - De Gijsel, David

AU - Brook, Daniel L.

AU - Friedmann, Peter D.

AU - Taylor, Lynn E.

AU - Feinberg, Judith

AU - Young, April M.

AU - Evon, Donna M.

AU - Herink, Megan

AU - Westergaard, Ryan

AU - Koepke, Ruth

AU - Havens, Jennifer R.

AU - Zule, William A.

AU - Delaney, Joseph A.

AU - Pho, Mai T.

PY - 2025/2/1

Y1 - 2025/2/1

N2 - Background: Restrictive Medicaid policies regarding hepatitis C virus (HCV) treatment may exacerbate rural health care disparities for people who use drugs (PWUD). We assessed associations between Medicaid restrictions and HCV treatment among rural PWUD. Methods: We compiled state-specific Medicaid treatment policies across 8 US rural sites in 10 states and merged these with participant survey data. We hypothesized that local restrictions regarding prescriber type, sobriety, and fibrosis estimates were associated with HCV treatment outcomes. We conducted a cross-sectional, ecological analysis of treatment restrictions and HCV treatment outcomes using bivariate analyses to characterize differences between PWUD who initiated HCV treatment and unadjusted logistic regressions to assess associations between restrictions and treatment. Results: Among 944 participants, 111 (12%) reported receiving HCV treatment. Participants receiving treatment were older [median age (interquartile range): 42 (34-53) vs. 35 (29-42), P<0.001], more likely to receive disability support (32% vs. 20%, P=0.002), and less likely to be Medicaid-insured (57% vs. 71%, P < 0.001). More PWUD in states without any restrictions reported receiving treatment (17% vs. 11%, P=0.08) and achieving HCV cure/clearance (42% vs. 30%, P=0.01) than in states with restrictions. Restrictions were associated with lower odds of receiving HCV treatment (odds ratio=0.61, 95% CI: 0.35-1.06, P=0.08). Sensitivity analyses showed a similar association with HCV cure/clearance (odds ratio=0.60, 95% CI: 0.40-0.91, P=0.02). Conclusions: We identified significant unadjusted associations between Medicaid restrictions and receipt of HCV treatment and cure, which has substantial implications for health outcomes among rural PWUD. Lifting remaining Medicaid restrictions will be critical to achieving HCV elimination.

AB - Background: Restrictive Medicaid policies regarding hepatitis C virus (HCV) treatment may exacerbate rural health care disparities for people who use drugs (PWUD). We assessed associations between Medicaid restrictions and HCV treatment among rural PWUD. Methods: We compiled state-specific Medicaid treatment policies across 8 US rural sites in 10 states and merged these with participant survey data. We hypothesized that local restrictions regarding prescriber type, sobriety, and fibrosis estimates were associated with HCV treatment outcomes. We conducted a cross-sectional, ecological analysis of treatment restrictions and HCV treatment outcomes using bivariate analyses to characterize differences between PWUD who initiated HCV treatment and unadjusted logistic regressions to assess associations between restrictions and treatment. Results: Among 944 participants, 111 (12%) reported receiving HCV treatment. Participants receiving treatment were older [median age (interquartile range): 42 (34-53) vs. 35 (29-42), P<0.001], more likely to receive disability support (32% vs. 20%, P=0.002), and less likely to be Medicaid-insured (57% vs. 71%, P < 0.001). More PWUD in states without any restrictions reported receiving treatment (17% vs. 11%, P=0.08) and achieving HCV cure/clearance (42% vs. 30%, P=0.01) than in states with restrictions. Restrictions were associated with lower odds of receiving HCV treatment (odds ratio=0.61, 95% CI: 0.35-1.06, P=0.08). Sensitivity analyses showed a similar association with HCV cure/clearance (odds ratio=0.60, 95% CI: 0.40-0.91, P=0.02). Conclusions: We identified significant unadjusted associations between Medicaid restrictions and receipt of HCV treatment and cure, which has substantial implications for health outcomes among rural PWUD. Lifting remaining Medicaid restrictions will be critical to achieving HCV elimination.

KW - Medicaid policy

KW - PWUD

KW - direct acting antivirals

KW - hepatitis C virus

KW - rural

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SP - 77

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ER -

Medicaid Policy and Hepatitis C Treatment Among Rural People Who Use Drugs

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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