Medicaid plays an important role as a source of insurance and care for individuals living with HBV and HCV, with estimates that 33 percent and 60 percent of individuals living with these viruses, respectively, are insured by a public insurance program. Furthermore, guidelines recommend universal screening for HBV and HCV, especially among pregnant and at-risk populations. Indeed, treatment for hepatitis C reduces mortality, transmission, and healthcare costs, while identifying individuals with either virus type can improve access to care and health outcomes. Despite this, most cases of HCV go untreated.
With support from AcademyHealth and the University of Pittsburgh, seven university research partnerships within the Medicaid Outcomes Distributed Research Network (MODRN) came together to develop an HBV/HCV quality measure. This new measure captures annual HBV testing, annual HCV testing, and hepatitis C treatment initiation (among those diagnosed with hepatitis C) within 6 months of testing among working age adult Medicaid enrollees (aged 18-64 years), those who were pregnant (for testing) or post-partum (for the treatment measure), and those with opioid use disorder (OUD).
In recognition of the importance of understanding the rates of HBV and HCV testing and hepatitis C treatment within the Medicaid program, this measure (Evaluation of Hepatitis B and C) has been adopted by the Centers for Medicare & Medicaid Services for inclusion in the 2027 Adult Core Set. The University of Pittsburgh, home of the data coordinating center for MODRN, will serve as the measure steward.
For more information on the HBV/HCV measure and how to adopt it in your state’s Adult Core Set, please visit the measure’s homepage at the University of Pittsburgh.