[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-283791-105":53,"doc-detail-283791-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","illinois-medicaid-hepatitis-c-treatment-access-assessment","Illinois Medicaid Hepatitis C Treatment Access Assessment","","Assessment of Illinois Medicaid access to hepatitis C treatment evaluates eligibility, coverage, and clinical restrictions across Fee-For-Service (FFS) and six HealthChoice Illinois managed care organizations (MCOs). The analysis highlights that FFS provides moderate access after removing prior restrictions, while still requiring documented fibrosis, attestation regarding ongoing alcohol or illicit IV drug misuse, and specialist involvement or consultation. MCO requirements vary and transparency is limited when coverage criteria are not publicly provided, lowering the overall state grade due to inconsistent barriers and information gaps.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/illinois-medicaid-hepatitis-c-treatment-access-assessment/283791/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/illinois-medicaid-hepatitis-c-treatment-access-assessment/283791.png","ImageObject",442,249,{"name":88,"@type":89},"Franzy","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-24","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":73},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"How does Illinois Medicaid Fee-For-Service (FFS) handle fibrosis and liver damage requirements for hepatitis C treatment?","Question",{"text":108,"@type":109},"FFS requires beneficiaries’ fibrosis score to be documented, but it does not require a minimum level of liver damage to qualify for treatment.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What sobriety-related requirements apply under FFS for hepatitis C treatment?",{"text":113,"@type":109},"FFS requires screening for active substance use. The FFS PA also requires the prescriber to attest that the provider is addressing ongoing misuse of alcohol and/or continued illicit IV drug use.",{"name":115,"@type":106,"acceptedAnswer":116},"Why is the overall grade for Illinois hepatitis C treatment access limited for some managed care organizations (MCOs)?",{"text":117,"@type":109},"MCO coverage requirements vary and transparency is lacking because some MCOs do not publicly provide hepatitis C coverage information, creating uncertainty about potential restrictions.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},283791,1790279399,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":73,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},2336478945519,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","| Illinois | |\n| --- | --- |\n| Estimated Number of Individuals Living with Hepatitis C: 54,9001 |  |\n\n\n| Grade | Summary\u003Cbr>|\n| --- | --- |\n| B- | Liver Damage (Fibrosis) Restrictions: Fee-For-Service (FFS) does not impose liver damage requirements. Three managed care organizations (MCOs), Blue Cross Community Health Plan, Aetna Better Health, and Molina, also do not impose liver damage requirements. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and YouthCare, do not provide hepatitis C coverage information publicly.\u003Cbr>Sobriety Restrictions: FFS requires screening for active substance use. Two MCOs, Blue Cross Community Health Plan and Molina, require that the provider attest that they will address any patient alcohol or drug misuse. Aetna Better Health requires three months’ abstinence from alcohol and substance use. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and Youthcare, do not provide hepatitis C coverage information publicly.\u003Cbr>Prescriber Restrictions: FFS requires a prescription to be written by or in consultation with a specialist. Two MCOs, Blue Cross Community Health Plan and Aetna Better Health, also require a specialist to prescribe or consult. One MCO, Molina, does not appear to impose prescriber requirements. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and YouthCare, do not provide hepatitis C coverage information publicly.\u003Cbr>Recommendations to Improve Patient Access:\u003Cbr>• Eliminate sobriety and prescriber restrictions.\u003Cbr>• Ensure parity across FFS and MCOs and transparency regarding hepatitis C coverage requirements for MCOs.\u003Cbr>Grade Rationale: Illinois FFS has moved to eliminate restrictions and provides moderate access. However, some MCOs appear to have more stringent coverage requirements, and transparency is lacking regarding coverage requirements for some MCOs. Because many MCOs have unclear or no public information about hepatitis C coverage, a “minus” has been added to the state’s B grade. |\n\nBackground  \nAs of May 2021, Illinois had 3, 331,614 individuals enrolled in Medicaid and Children Health Insurance Program.2 The Illinois Department of Healthcare and Family Services (HFS) administers the Medicaid program. HFS delivers health care services through Fee-For-Service (FFS) and MCOs, with 80 percent of beneficiaries enrolled in an MCO.3 Illinois contracts with six MCOs as part of the HealthChoice Illinois managed care program, for non-dual eligible beneficiaries: Blue Cross Community Health Plans, CountyCare Health Plan, Aetna Better Health (formerly Illinicare Health), MeridianHealth Plan, Molina, and YouthCare (specifically serving youth currently and formerly under the care of the Illinois Department of Children & Family Services) .4  \nState of Medicaid Hepatitis C Treatment Access  \nIllinois Medicaid FFS provides moderate access to hepatitis C medications. Due to pressure from legal advocates, FFS has made improvements in opening access by removing past restrictions.5 While beneficiaries’ fibrosis score must be documented, FFS does not require a minimum level of liver damage to quality for treatment.6 FFS does not require a minimum period of sobriety prior to treatment. However, the FFS PA requires the prescriber to attest that “he or she is addressing the ongoing misuse of alcohol and/or continued use of illicit IV drugs,” and the clinical criteria states that the provider is responsible for addressing ongoing substance use.7 FFS requires a prescription to be written either by a specialist (gastroenterologist, hepatologist, transplant hepatologist, or infectious disease specialist) or with a one-time consultation with a specialist within the 3 months prior to requesting treatment.8 The Preferred Drug List (PDL) includes Mavyret and sofosbuvir/velpatasvir as preferred and Harvoni, Sovaldi, Epclusa, Viekira Pak, Vosevi, ledipasvir/sofosbuvir, and Zepatier as non-preferred.9  \nMCOs coverage requirements vary. Transparency is lacking as three MCOs do not pro","cbCaioBPhzOPqsEE","https://ap.wps.com/l/cbCaioBPhzOPqsEE","pdf",258117,"English","# Estimated Number of Individuals Living with Hepatitis C\n# Grade Summary\n## Grade B Rationale\n# Background: Illinois Medicaid and Managed Care\n# State of Medicaid Hepatitis C Treatment Access\n## Illinois Medicaid FFS\n## MCO Coverage Requirements","[{\"question\":\"How does Illinois Medicaid Fee-For-Service (FFS) handle fibrosis and liver damage requirements for hepatitis C treatment?\",\"answer\":\"FFS requires beneficiaries’ fibrosis score to be documented, but it does not require a minimum level of liver damage to qualify for treatment.\"},{\"question\":\"What sobriety-related requirements apply under FFS for hepatitis C treatment?\",\"answer\":\"FFS requires screening for active substance use. The FFS PA also requires the prescriber to attest that the provider is addressing ongoing misuse of alcohol and/or continued illicit IV drug use.\"},{\"question\":\"Why is the overall grade for Illinois hepatitis C treatment access limited for some managed care organizations (MCOs)?\",\"answer\":\"MCO coverage requirements vary and transparency is lacking because some MCOs do not publicly provide hepatitis C coverage information, creating uncertainty about potential restrictions.\"}]","Illinois Medicaid Hepatitis C Treatment Access Assessment | PDF",1789619525]