Daniel Raymond is the Director of Policy at the National Viral Hepatitis Roundtable (NVHR), a program of the Hepatitis Education Project (HEP). In this role, he leads federal and state policy initiatives focused on expanding access to hepatitis prevention, testing, treatment, and harm reduction services, working closely with advocates, public health leaders, and policymakers to advance viral hepatitis elimination efforts nationwide.
CMS recently finalized the inclusion of Hepatitis B and C screening measures in the 2027 Adult Core Set. What does this mean specifically for expanding routine hepatitis testing across Medicaid populations?
Over the past several years, the CDC has shifted toward recommending one-time universal screening for hepatitis C and hepatitis B among all adults, moving away from earlier risk-based testing approaches. However, implementation has lagged, and there is still a long way to go to ensure that adults across the United States receive appropriate hepatitis screening.
The new Adult Core Set measures are designed to establish how much hepatitis testing is currently occurring among Medicaid beneficiaries, giving states a baseline to track progress over time. States that adopt these measures and report their testing rates will enable public health officials, providers, community-based organizations, and patient advocates to better understand where testing is happening and where gaps remain – helping to identify opportunities to expand routine testing and improve early diagnosis.
Closing Longstanding Gaps in Hepatitis Screening
Historically, Hepatitis B and C testing rates have fallen short of clinical recommendations. How could inclusion in the Adult Core Set help close gaps in routine and risk-based screening?
These measures help states take a closer look at whether their screening efforts align with national recommendations. In many cases, providers and healthcare systems may believe they are identifying people who should be tested, but the data may show that significant gaps remain.
Routine hepatitis screening has not yet been fully integrated into many healthcare settings for a variety of reasons, including competing priorities, limited incentives, and gaps in policy or implementation. By measuring testing rates across Medicaid programs, the Adult Core Set gives states an opportunity to assess where screening is falling short – whether in hospital emergency departments, federally qualified health centers, or other care settings – and identify where additional leadership or systems changes may be needed. Ultimately, these measures can help move universal hepatitis screening from a recommendation into routine practice.
Overcoming Structural Barriers to Testing
What barriers currently limit Hepatitis B and C testing in Medicaid programs – such as provider awareness, reimbursement, prior authorization, and workflow integration- and how might these new measures catalyze change among Medicaid agencies and healthcare providers?
One of the most important dynamics in healthcare quality improvement is that what gets measured tends to get prioritized. If screening rates are not tracked or reported, it can signal that hepatitis testing is not a major public health priority. By introducing standardized measures, the Adult Core Set brings hepatitis screening into focus and makes gaps visible and actionable.
Once states begin to see their testing data, Medicaid agencies may work with managed care organizations and providers to expand training on screening guidelines, introduce electronic health record prompts or standing orders for testing, clarify billing codes with laboratories, or create incentives for routine screening. These measures can also support collaboration with academic medical centers and public health partners to strengthen provider education.
Advancing Equity in Hepatitis B and C Screening
Viral hepatitis testing remains uneven across populations and geographies. How can these new quality measures help improve equitable access to Hepatitis B and C screening, particularly in high-burden communities?
While detailed data on testing rates by race or ethnicity are still limited, the developers of these measures included certain subpopulations where improved screening data could provide important insights. For example, the measures include screening during pregnancy, which is particularly important for hepatitis B because of the risk of perinatal transmission. There has also been growing attention to hepatitis C among pregnant women, where screening can help identify infections and reduce the risk of transmission to infants.
Another key population included in the measures is people diagnosed with substance use disorder. Injection drug use has contributed significantly to new hepatitis C infections and is also associated with hepatitis B transmission. Measuring screening rates among individuals with substance use disorders can highlight opportunities to improve testing and linkage to care.
More broadly, Medicaid serves many people who face structural barriers to healthcare access, including individuals with lower incomes and those living in rural communities. As states analyze Medicaid screening data, it may reveal geographic or population-level patterns that can inform targeted public health strategies.
Strengthening Data, Accountability, and Public Health Planning
From a policy standpoint, how important is standardized, comparable data reporting for Hepatitis B and C testing across states?
Strong public health strategies depend on reliable and comparable data. For hepatitis B and hepatitis C, much of what we know about testing or treatment patterns comes from occasional research studies or analyses of large laboratory datasets, which can provide useful snapshots but are often difficult to access or update.
The Adult Core Set measures offer the potential to generate consistent, annually reported data across states using standardized definitions and methods. This allows policymakers, researchers, and public health leaders to examine trends over time, compare performance across states, identify where progress is being made, and determine which strategies are most effective — supporting more strategic planning to accelerate hepatitis elimination efforts.
Preparing States for 2027 Implementation
As states prepare for implementation in 2027, what steps should Medicaid programs and healthcare systems take now—and what are the benefits of adopting these measures given that participation is voluntary?
States must choose to opt into reporting these measures, which makes early engagement important. Medicaid programs should review the measures and consult with partners across public health agencies, community-based organizations, patient groups, and healthcare providers to understand their potential value.
Expanding adoption across states will be critical to generating meaningful national insights. By adopting these measures and analyzing testing data, states can better understand hepatitis testing patterns, identify opportunities to improve screening and prevention, and potentially reduce long-term healthcare costs associated with untreated hepatitis infections. These measures also give Medicaid programs and public health agencies an opportunity to better leverage Medicaid data to support hepatitis elimination efforts and strengthen coordination across healthcare and public health systems.
