Medicaid treated 23% of hepatitis C patients within 6 months

Only 23% of Medicaid enrollees with hepatitis C got treatment within 6 months of testing, the HHS Office of Inspector General said in a report posted Nov. 2. The watchdog counted about 230,000 Medicaid enrollees with the virus in 2023.

The drugs that cure it are pills. They cure more than 95% of cases and can clear the virus in as little as 8 weeks, the full report says. Medical guidance calls for treating nearly every patient right away.

Most people with Medicaid who tested positive did not get them.

Who got left out

The gaps were widest for people who are older, newly infected or covered by both Medicare and Medicaid.

People on both programs, called dual eligibles, got treated 14% of the time. Medicaid only enrollees got treated 28% of the time. Dual eligibles made up a third of the patients in the study, and Medicare pays first for their drugs.

Among enrollees 65 and older, 12% got treated within 6 months. More than a quarter of adults ages 19 to 64 did. The Centers for Disease Control and Prevention says the hepatitis C death rate is highest among people 65 to 74, according to the report.

Newly infected patients fared worst of all. Of about 9,000 enrollees with only an acute, or recent, infection, 5% got treated. During the review period, the drugs were approved only for chronic infection. One widely used drug added recent infection to its label in June 2025.

Where you live matters

State rates ran from 7% to 41%. Even in the best states, only 4 in 10 Medicaid only enrollees got treated within 6 months.

Many states once required prior approval, sobriety rules or a specialist’s prescription before covering the drugs. Some have dropped those rules as cheaper versions came out. At least 7 states removed prior approval during the 2023 and 2024 review period, the report says. The watchdog said it could not separate the effect of state rules from other factors.

Treatment also took time. For those who got the drugs within 6 months, the typical wait was 49 days from test to prescription. A quarter waited more than 90 days.

What untreated hepatitis C costs

Hepatitis C infects more than 2 million Americans and was tied to more than 11,000 deaths in 2023, the report says. Left untreated, it can lead to liver damage, cancer and death.

Medicaid spends almost 3 times more on enrollees diagnosed with hepatitis C than on those without it, according to a CMS estimate cited in the report. A Congressional Budget Office analysis found that raising Medicaid treatment rates by 10% would save the federal government $700 million over 10 years.

Primary care doctors wrote 41% of first prescriptions for patients treated within 6 months. Liver and infectious disease specialists wrote 33%.

What happens next

The watchdog asked CMS to push states to treat more patients and to target dual eligibles directly. CMS agreed with both recommendations in a Sept. 25 letter included in the report.

Starting in 2027, state Medicaid programs can report hepatitis C treatment rates to CMS under a new voluntary quality measure.

What it means for you

If you have Medicaid or Medicare and tested positive for hepatitis C, ask your doctor about treatment now. A primary care doctor can prescribe it. If your plan requires prior approval, ask the plan what it needs and how long it takes.