In 2016, the World Health Organization set a global target to eliminate hepatitis C as a public health threat by 2030 — defined as a 90% reduction in new infections and an 80% reduction in hepatitis C mortality. The United States had a credible path to that goal. Direct-acting antiviral (DAA) medications like sofosbuvir-velpatasvir (Epclusa) and glecaprevir-pibrentasvir (Mavyret) cure hepatitis C in more than 95% of treated patients with an 8-to-12-week oral regimen, at costs that have declined dramatically from the original $84,000 treatment prices.
The CDC's National Hepatitis C Elimination Plan, launched formally in 2023, had deployed testing expansion, harm reduction integration, and medication access programs in the highest-burden communities. In California — home to the nation's largest hepatitis C burden, concentrated in Los Angeles and San Francisco — the progress was measurable.
That progress is now at serious risk. The combination of federal healthcare funding reductions under H.R. 1, the elimination or reduction of CDC community hepatitis programs under the Trump administration's broader public health restructuring, and the SNAP and Medicaid cuts that are removing the insurance coverage through which many hepatitis C patients access DAA medications is creating a retreat from elimination that infectious disease specialists are watching with alarm.
A hepatitis C elimination analysis published by the National Viral Hepatitis Roundtable in May 2026 found that funding shortfalls for the National Hepatitis C Elimination Plan have already stalled or reversed testing expansion in at least 18 states — including California. Los Angeles County, which has the highest hepatitis C burden of any California county and where the overlap between HCV infection, homelessness, and injection drug use creates a concentrated epidemic, is now operating hepatitis C outreach programs at reduced capacity compared to their 2024 peak.
The Scale of Los Angeles County's Hepatitis C Burden
Approximately 130,000 Los Angeles County residents are estimated to be living with chronic hepatitis C — one of the largest metropolitan concentrations of HCV infection in the United States. The majority are undiagnosed or diagnosed but untreated. The disease progresses silently over 15 to 30 years, causing liver fibrosis, cirrhosis, and ultimately hepatocellular carcinoma — the most rapidly rising form of cancer in the United States — in approximately 20–30% of chronically infected individuals.
Deaths from hepatitis C now exceed deaths from HIV in the United States. And unlike HIV, hepatitis C is curable: an 8-to-12-week pill regimen eliminates the virus in 95%+ of patients. The barrier is not the drug — it is finding patients, getting them diagnosed, and maintaining the insurance and clinical infrastructure to prescribe and fill their treatment.
LA County's hepatitis C elimination program, administered through the Los Angeles County Department of Public Health and implemented through a network of community health clinics and harm reduction organizations, was reaching thousands of new patients annually through integrated testing at homeless shelters, syringe service programs, and county jail medical services.
California's Medi-Cal program covers DAA medications with minimal prior authorization requirements — a coverage framework that made California a national leader in hepatitis C treatment access among Medicaid populations. The Medi-Cal cuts under H.R. 1 — disenrolling 200,000 LA County residents and threatening up to 3 million statewide by 2028 — directly remove the coverage mechanism through which the most vulnerable, hardest-to-reach hepatitis C patients access curative treatment.
San Francisco's Experience: What's Being Lost
San Francisco Bay Area's hepatitis C elimination effort represents the most advanced urban HCV elimination program in the United States, developed through a formal city-county collaboration and based on the New York State hepatitis C elimination model. San Francisco identified all HCV-positive patients in the county health system, linked them to care, and achieved treatment rates among the highest of any urban jurisdiction in the country. That program's success depended on Medi-Cal coverage for DAA medications and on the city's community health worker infrastructure — both of which are now at risk from the same federal and state budget pressures affecting Los Angeles.
For LA County residents who think they may have been exposed to hepatitis C — through injection drug use (current or past), blood transfusions before 1992, organ transplants before 1992, being born to an HCV-positive mother, or receiving tattoos or piercings in unsterile environments — free or low-cost hepatitis C testing is available through LA County Public Health clinics, federally qualified health centers, and the APLA Health hepatitis C testing and treatment program.
The CDC recommends universal HCV screening for all adults aged 18 to 79 at least once in a lifetime, with more frequent testing for people with ongoing risk factors. A simple blood test can determine both HCV antibody positivity (indicating prior exposure) and active infection (indicating current virus). If you have never been tested, today is the right time — especially if you were born between 1945 and 1965, the cohort with the highest HCV prevalence in the country.
