Arkansas Treated 7 Percent of Its Medicaid Hepatitis C Patients Within Six Months. Indiana Treated 41 Percent.
An inspector general table ranks state Medicaid hepatitis C treatment rates. By our estimate, five states hold 37 percent of 113,000 untreated patients.
In Arkansas, 7 percent of Medicaid patients identified with hepatitis C started curative treatment within six months of testing. In Indiana, 41 percent did. Those are the bottom and top of a state-by-state table in a new data brief from the Department of Health and Human Services Office of Inspector General.
The brief, OEI-BL-24-00450, is dated October 2026 and uses 2023 and 2024 Medicaid and Medicare claims. It found that 23 percent of about 230,000 Medicaid beneficiaries with hepatitis C received a direct-acting antiviral within six months of the test that led to their diagnosis. The headline number has been reported. The state appendix, which ranks 49 states, the District of Columbia and Puerto Rico, with Wyoming withheld for small numbers, says more about where the untreated patients actually are.
How did the inspector general measure treatment?
OIG counted a beneficiary as having active hepatitis C when a 2023 claim showed a hepatitis C test followed within six months by a hepatitis C diagnosis. It then searched pharmacy claims for a direct-acting antiviral within six months of that test. It excluded children under 3, beneficiaries treated in the six months before the test and people without full Medicaid benefits. The state table covers about 156,000 Medicaid-only beneficiaries; dual-eligible patients were left out of state rates because Medicare pays for their drugs. OIG did not review medical records or lab results, and treatment paid outside Medicaid or Medicare would not appear.
Nationally, 28 percent of Medicaid-only patients and 14 percent of dual-eligible patients were treated in the window. Among about 9,000 patients with an acute-only diagnosis, 5 percent were. Patients who were treated started a median 49 days after testing.
Where are the untreated patients?
They are concentrated in a few large programs, including some with above-average rates. We multiplied each state's patient count by the share not treated to estimate how many patients in each state did not start treatment within six months. Across the 51 jurisdictions OIG published, that comes to about 113,000 of 157,000 patients. Wyoming's rate is below 22 percent, OIG says, but its count is not shown.
Our estimate of patients not treated within six months, largest first (OIG's patient count and treatment rate in parentheses):
California, about 12,200 (15,802; 23 percent). New York, about 8,000 (9,928; 19 percent). Ohio, about 7,700 (12,268; 37 percent). Pennsylvania, about 7,500 (11,193; 33 percent). Illinois, about 6,700 (7,371; 9 percent). Kentucky, about 6,400 (10,661; 40 percent). Massachusetts, about 3,800 (5,144; 26 percent). Puerto Rico, about 3,500 (3,878; 10 percent).
By our arithmetic, those eight programs account for about 49 percent of the estimated untreated total. The top five, California, New York, Ohio, Pennsylvania and Illinois, account for 37 percent. Ohio and Kentucky sit near the top of the rate table and still have more untreated patients than all but a handful of states, because they identified so many patients. Illinois and Puerto Rico are the outliers in the other direction: large caseloads and treatment rates near 10 percent.
Seven jurisdictions fell below 20 percent: Rhode Island, New York and Nevada at 19 percent, South Carolina at 16, Puerto Rico at 10, Illinois at 9 and Arkansas at 7. Twenty-two were at 30 percent or above. These rates are rounded and some state counts are small; Vermont's 40 percent rests on 43 patients.
A high treatment rate in a large state can still leave thousands untreated. For a practice, the question is what happens in the seven weeks after a positive test.
What explains the gap?
OIG does not say. It writes that state coverage restrictions "may play a role" but that it could not separate their effect from prescriber availability, familiarity with treatment, care coordination, comorbidities and stigma, partly because state policies changed during the review period. It notes that at least seven states removed prior authorization requirements for some hepatitis C drugs during 2023 and 2024.
Earlier federal work points the same way without settling it. A 2022 Centers for Disease Control and Prevention Vital Signs report found that 23 percent of Medicaid patients diagnosed in 2019 and 2020 were treated within a year, against 35 percent of privately insured patients, and that Medicaid patients in states with treatment restrictions had 23 percent lower adjusted odds of timely treatment. OIG reads the same CDC data as 17 percent treated within six months, which would put the new national figure modestly higher, though the two studies define their populations differently.
Primary care already does much of the prescribing. Primary care clinicians wrote the first prescription for 41 percent of treated patients in the OIG data, and gastroenterology, hepatology and infectious disease specialists wrote 33 percent. Many states first required specialist prescribing, OIG notes, and many have since eased those rules.
What happens next?
CMS concurred with both recommendations: to take further steps to raise Medicaid treatment rates and to target dual-eligible patients. Its main lever is a new voluntary hepatitis B and C measure in the 2027 Medicaid Adult Core Set, covering adult, non-dual-eligible beneficiaries tested for hepatitis B and C and treated for hepatitis C. CMS wrote that states will report it in fall 2027, for services mostly provided in 2026. In other words, the first state-reported treatment rates will reflect care delivered this year.
For clinicians, the brief's most usable finding is the timeline. One-third of treated patients started within 30 days, and a quarter waited more than 90. Current clinical guidance, as OIG summarizes it, is to treat at diagnosis regardless of stage, and since June 2025 one widely used regimen carries an FDA indication for acute infection. Practices that test can check their own lag from positive RNA to first fill and see whether a prior authorization or referral step is adding weeks. For context on how state Medicaid rules shape access, see our coverage of the medically frail fight over Medicaid's work requirement, and on viral hepatitis treatment, the bepirovirsen approval for chronic hepatitis B. The next marker is fall 2027, when the first voluntary state reports on the new measure arrive.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
