Less Restrictive Medicaid Policies for Direct‐Acting Antiviral Access Are Associated With Greater Declines in Hepatocellular Carcinoma Deaths

ABSTRACT Background In the United States (US), chronic hepatitis C virus (HCV) is the leading cause of hepatocellular carcinoma (HCC). Direct‐acting antivirals (DAAs) cure HCV and reduce HCC risk, but Medicaid DAA coverage varies across states. Aim We assessed whether Medicaid DAA access was associated with trends in HCC‐related deaths. Methods We analyzed CDC WONDER death certificate data (1999–2023) to assess HCC‐related mortality. US states were grouped based on Medicaid DAA prior authorization restrictions using the Hepatitis C: State of Medicaid Access scoring system: A+/A ( n = 28), B ( n = 11), and C/D ( n = 12). We used NCI Joinpoint software to calculate the annual percentage change (APC) and average annual percent change (AAPC) in age‐adjusted death rate. State‐specific HCC crude death rates were analyzed before and after 2014, alongside changes in Medicaid DAA policies from 2014 to 2024. Results Before 2017, HCC‐related death rates were positive in group A + /A (APC 2.01, 1999–2017), group B (APC 3.40, 1999–2009), and group C/D (APC 2.04, 1999–2023). Age‐adjusted death rates became negative in group A+/A states (APC −0.19, 2017–2023), while death rates continued to be positive for group B states (APC 1.49, 2009–2023) and group C/D states (APC 2.04, 2017–2023). The AAPC (1999–2023) was lowest in group A + /A (1.46), followed by group B (2.28) and C/D (2.04). From 2014 to 2024 accessibility to DAAs improved. Conclusion Increased DAA access was associated with reduced HCC‐related death rates. Improved HCV treatment could contribute to decreased HCC incidence and recurrence, enhance linkage to subspecialty care, and prevent liver‐related decompensation.