Md. hepatitis C treatment funding leaves key group behind

When I entered community health 13 years ago, treatment for hepatitis C — the deadliest infectious disease in the United States — was available, but only half of those who received it were actually cured. Treatment took a full year and made patients feel like they had the flu the entire time. Because of this, we carefully screened patients to make sure they could withstand such a rigorous regimen.

During this time, I told John and Regina, two of my patients with hepatitis C, that there were whispers of a new medication that would revolutionize hepatitis C care. I urged them to wait for it. The new drugs were said to cure 90% of people with hepatitis C in three months with minimal side effects. But there was a catch: Maryland Medicaid only covered treatment for people with significant liver damage, citing high costs.


As a result, only one of my two patients was eligible for the cure when it became available.

John had severe liver damage, but after a few months of the new treatment, he was free of a disease that had been haunting him for years. He no longer had to worry about his liver failing or of passing hepatitis C on to others. A burden was lifted off of him.


For Regina, the story was different. Because she did not have “enough” liver damage, I couldn’t treat her the same way. And I had to tell her that I could only fully help her if her liver got worse. We checked her liver every six months, but the level of damage didn’t change. I had to apologize every time for a rule that didn’t make any sense.

There is a significant cost to not treating hepatitis C, which spreads most commonly through injection drug use, and significant benefits to earlier eradication. Failure to provide appropriate access to hepatitis C treatment threatens the health of millions of our most vulnerable residents and continues inequities in poor and marginalized populations.

During this year’s Maryland General Assembly session, Sen. Shirley Nathan-Pulliam and Del. Jheanelle Wilkins led the charge in passing legislation that mandates Medicaid coverage for hepatitis C, regardless of the amount liver damage, if any, but makes it subject to the availability of state funds. Gov. Larry Hogan signed the bill into law in May, and it takes effect today. But because of a budget loophole, the restrictions on treatment are not yet being fully lifted, despite the mandate to do so, meaning some liver damage will still be required for treatment.

By choosing not to fully fund treatment for everyone with hepatitis C — and make no mistake, this is a choice — the state is actively maintaining health disparities among the poorest in Maryland. To rapidly expand this life saving treatment, I urge the state to:

  • Fully fund treatment for everyone now;
  • Expand public-private training programs to educate primary care providers to treat hepatitis C and become approved hepatitis C treatment providers for Medicaid;
  • Streamline paperwork burdens to eliminate conflicting and confusing prior authorizations that impede care.

These steps would bring Maryland to the forefront of the nation in curing hepatitis C and decreasing the spread of this disease. And it would mean that when I see a new patient and give them the news that they have hepatitis C, I could confidently tell them, “We have a treatment for that, let’s get started.”

Dr. Nilesh Kalyanaraman ( is chief health officer at Health Care for the Homeless.