The Affordable Care Act (ACA) roll out has an effect on many aspects of HIV and Hepatitis C Virus (HCV) care.  Carl Schmid, the Deputy Executive Director at the AIDS Institute hosted a webinar on July 10, 2014 entitled, "Coverage of Hepatitis C Testing Under the Affordable Care Act."

Currently in the United States, there are about 2.7-3.9 million people with chronic hepatitis C.  According to a recent meta-analysis, half of these people are unaware of their infection due to lack of HCV testing.

Source: Yehia, PLOS ONE, 2014

Both the United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC) recommend a one time screening for HCV of baby boomers (adults born between 1945-1965) without prior risk ascertainment, and periodic screening for people at risk of HCV infection.  The risk definition includes: current/past history of illicit injection drug use, history of receiving blood transfusion prior to 1992, long-term hemodialysis, born to an HCV-infected mother, history of incarceration, intranasal drug use, unregulated tattoos, and other percutaneous exposures.

In this July 10, 2014 webinar, Mr. Schmid described the importance of USPSTF recommendation grades.  Under the ACA, coverage is based on these grades - all plans are required to cover graded A and B services without cost sharing.  This applies to plans both inside and outside the marketplace, and excludes grandfathered plans.  Currently, Medicare covers all A and B graded preventive services after a National Coverage Determination (NCD) process.  Last month, Medicare finalized HCV screening with no cost sharing.  This includes a one time screening of baby boomers and people at risk of HCV infection, with annual screening for people whose risk is ongoing.  This only covers primary care settings, so emergency room testing would not be covered for Medicare beneficiaries.

As for Medicaid, traditionally it is the state's decision to cover HCV testing if it is not medically necessary, with or without copayment.  The ACA incentivizes states to cover USPSTF grading A and B services, and participating states so far include: California, Colorado, Hawaii, Kentucky, New Hampshire, New Jersey, Nevada, New York, Ohio, and Wyoming.

Source: Kaiser Family Foundation

With expanded Medicaid, participating states are required to provide one time HCV testing for at risk and baby boomers without cost sharing.  Although the USPSTF recommendations and ACA policies undoubtedly will improve HCV testing rates, there are still many more issues to tackle before the U.S. HCV burden can be ameliorated.  State advocacy will be required to expand Medicaid, education and outreach are necessary to implement recommendations, and entities must develop tools for billing.  After individuals test positive, there also lacks funding for staffing, outreach, and linkage to care and treatment.  There is a long path ahead towards HCV elimination, but the USPSTF recommendations and ACA policies helps to take a big step forward.