Impact of the Centers for Disease Control and Prevention Recommendation and State Law on Birth Cohort Hepatitis C Screening of New York City Medicaid Recipients


      The Centers for Disease Control and Prevention estimated that, during 1999–2008, people born in 1945–1965 (the baby boomer generation) represented approximately 75% of people infected with hepatitis C virus and 73% of hepatitis C virus–associated deaths and are at greatest risk for hepatocellular carcinoma and liver disease. In 2012, the Centers for Disease Control and Prevention recommended one-time hepatitis C virus screening for people born during 1945–1965. In addition, New York State enacted a Hepatitis C Virus Testing Law in 2014. This analysis assesses the impacts of the 2012 recommendation and 2014 New York State Testing Law on hepatitis C virus screening rates among New York City Medicaid-enrolled recipients born during 1945–1965.


      The eligible population was determined quarterly as the number of Medicaid recipients continuously enrolled for 12 months with neither a prior hepatitis C virus diagnosis nor antibody test since 2005. Quarterly screening rates during 2010–2017 were examined using interrupted time series analysis. Data were analyzed in 2018–2019.


      In 2010–2017, the highest screening rate occurred in the quarter immediately after the law (33.64 per 1,000 Medicaid recipients). There was no change in screening rates after the Centers for Disease Control and Prevention recommendation and a significant increase after the New York State Law, which was not sustained.


      Hepatitis C virus screening rates increased in the quarter after the 2014 New York State Hepatitis C Virus Testing Law became effective. Additional efforts are needed to screen baby boomers and people who were recently infected with hepatitis C virus related to opioid use.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Smith BD
        • Morgan RL
        • Beckett GA
        • et al.
        Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965.
        MMWR Recomm Rep. 2012; 61: 1-32
        • Hofmeister MG
        • Rosenthal EM
        • Barker LK
        • et al.
        Estimating prevalence of hepatitis C virus infection in the United States, 2013-2016.
        Hepatology. 2019; 69: 1020-1031
        • Kim HS
        • Yang JD
        • El-Serag HB
        • Kanwal F
        Awareness of chronic viral hepatitis in the United States: an update from National Health and Nutrition Examination Survey.
        J Viral Hepat. 2019; 26: 596-602
      1. Required offering of hepatitis C screening testing, New York Public Health Law §2171 [January 1, 2014]. Accessed March 13, 2020.

        • Flanigan CA
        • Leung SJ
        • Rowe KA
        • et al.
        Evaluation of the impact of mandating health care providers to offer hepatitis C virus screening to all persons born during 1945-1965 - New York, 2014.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 1023-1026
        • Barocas JA
        • Wang J
        • White LF
        • et al.
        Hepatitis C testing increased among baby boomers following the 2012 change to CDC testing recommendations.
        Health Aff (Millwood). 2017; 36: 2142-2150
        • Isenhour CJ
        • Hariri SH
        • Hales CM
        • Vellozzi CJ
        Hepatitis C antibody testing in a commercially insured population, 2005-2014.
        Am J Prev Med. 2017; 52: 625-631
        • Hall EW
        • Rosenberg ES
        • Sullivan PS
        Estimates of state-level chronic hepatitis C virus infection, stratified by race and sex, United States, 2010.
        BMC Infect Dis. 2018; 18: 224
        • Bailey ZD
        • Krieger N
        • Agénor M
        • Graves J
        • Linos N
        • Bassett MT
        Structural racism and health inequities in the USA: evidence and interventions.
        Lancet. 2017; 389: 1453-1463
        • Penfold RB
        • Zhang F
        Use of interrupted time series analysis in evaluating health care quality improvements.
        Acad Pediatr. 2013; 13: S38-S44
        • Wagner AK
        • Soumerai SB
        • Zhang F
        • Ross-Degnan D
        Segmented regression analysis of interrupted time series studies in medication use research.
        J Clin Pharm Ther. 2002; 27: 299-309
        • Vijayadeva V
        • Spradling PR
        • Moorman AC
        • et al.
        Hepatitis B virus infection testing and prevalence among Asian and Pacific Islanders.
        Am J Manag Care. 2014; 20: e98-e104
        • Terrault NA
        • Lok ASF
        • McMahon BJ
        • et al.
        Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.
        Hepatology. 2018; 67: 1560-1599
        • Weinbaum CM
        • Williams I
        • Mast EE
        • et al.
        Recommendations for identification and public health management of persons with chronic hepatitis B virus infection.
        MMWR Recomm Rep. 2008; 57 (RR-8:1‒20)
        • Panel on Opportunistic Infections in Adults and Adolescents with HIV
        Guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the NIH, and the HIV Medicine Association of the Infectious Diseases Society of America.
        2020 (Published)
        • HIV Epidemiology Program
        HIV Surveillance Annual Report, 2018.
        New York City Department of Health and Mental Hygiene, New York, NY2019
        • Roberts ET
        • Pollack CE
        Does churning in Medicaid affect health care use?.
        Med Care. 2016; 54: 483-489
        • Akiyama MJ
        • Kaba F
        • Rosner Z
        • Alper H
        • Holzman RS
        • MacDonald R
        Hepatitis C screening of the “birth cohort” (born 1945-1965) and younger inmates of New York City jails.
        Am J Public Health. 2016; 106: 1276-1277
        • Eckman MH
        • Ward JW
        • Sherman KE
        Cost effectiveness of universal screening for hepatitis C virus infection in the era of direct-acting, pangenotypic treatment regimens.
        Clin Gastroenterol Hepatol. 2019; 17: 930-939
        • HCV guidance: recommendations for testing, managing, and treating hepatitis C
        Recommendation for universal hepatitis C screening in pregnancy.
        American Association for the Study of Liver Diseases (AASLD), 2018 (Published May 24Updated 2019)