Approving the settlement agreement between the Health and Human Services Commission and plaintiffs Coleman, Jackson, and Perez.
Under the terms of the settlement approved by HCR56, significant changes will be made to the prior authorization criteria used by the HHSC. Specifically, the resolution mandates that chronic Hepatitis C patients who have certain METAVIR fibrosis scores (F2-F4) will be eligible for Direct Acting Antiviral (DAA) treatment without prior restrictive measures starting March 1, 2021. Furthermore, patients with severe extrahepatic effects will be considered for treatment on a case-by-case basis, ensuring a more responsive healthcare approach for vulnerable Medicaid enrollee populations.
HCR56 is a House Concurrent Resolution that approves a settlement agreement reached between the Texas Health and Human Services Commission (HHSC) and plaintiffs Dorena Coleman, Curtis Jackson, and Federico Perez, who filed a lawsuit alleging discrimination against Medicaid recipients based on prior authorization policies related to hepatitis C treatments. The lawsuit contended that these policies created unjust barriers that violated the Social Security Act by denying medically necessary treatments to qualified individuals, thus requiring reform of the policy to ensure fairness in healthcare access.
HCR56 aims to enhance equitable healthcare access for individuals suffering from chronic Hepatitis C by modifying prior authorization criteria that previously imposed stringent restrictions on Medicaid beneficiaries. This legislative action not only highlights the importance of class action lawsuits in prompting policy reforms but also underscores the ongoing challenges related to healthcare access, funding, and regulation within the Texas Medicaid system.
The settlement, however, is contingent upon legislative approval of funding necessary for these changes, which may lead to debates within the legislature about resource allocation and budgeting for public health programs. The resolution provides that from September 1, 2021, until August 31, 2023, the HHSC will not return to prior authorization requirements that could limit access to treatment, suggesting a transitional period aimed at addressing systemic health disparities faced by Medicaid patients.