Case Studies: Medicaid Managed Care Plan Best Practices in Hepatitis C Linkage to Care, Treatment, and Retention

As more states consider initiatives to eliminate hepatitis C, Medicaid managed care organizations (MCOs) play a key role in developing best practices for hepatitis C treatment, linkage to care, and retention. More than two-thirds of all Medicaid beneficiaries nationally receive most or all of their care from risk-based MCOs, and many states are moving to expand their use of MCOs to serve more medically complex beneficiaries, deliver long-term services and supports, and serve low-income adults newly eligible for Medicaid under the Affordable Care Act’s Medicaid expansion.

Due to the high prevalence of hepatitis C among Medicaid populations, along with budgeting constraints that limit state Medicaid programs’ ability to manage the use of costly treatments among large populations of patients, Medicaid MCOs play a leading role in care provision for people living with hepatitis C. This paper highlights policies and practices implemented by non-profit MCOs across the country and is a resource for governmental public health hepatitis programs and MCOs seeking to develop innovative practices for the delivery of hepatitis C services.