Healthcare Systems Bureau, the HIV/AIDS Bureau, the Maternal and Child Health Bureau, the Office of Minority Health and Health Disparities, the Office of Planning and Evaluation, the Office of Rural Health Policy, and the Center for Quality (Raggio Ashley, 2009). In addition, viral hepatitis education and training activities are administered by the Bureau of Health Professions. HRSA funding supports federally qualified health centers that serve migrant, rural, tribal, and homeless populations. It also provides funding for Ryan White Care Act services and maternal and child health programs, such as Title V and Healthy Start, which provides some hepatitis B vaccination, testing, and counseling for HBV and HCV infections. Many people in HRSA-funded programs are foreign-born, including people from countries that have a high prevalence of hepatitis B or have behavior risk factors for HBV and HCV infection.

CMS, also a part of DHHS, provides health insurance through Medicare and Medicaid programs. Medicare covers people 65 years old or older, people under 65 years old who have specified disabilities, and people who have end-stage renal disease. Hepatitis B vaccination and its administration costs are covered by Part B of Medicare for people at high or intermediate risk for HBV infection (Rogers, 2009). People at low risk for HBV infection can receive the vaccine under Part D with a copayment that depends on their income level. Medicare will cover laboratory testing for HBV and HCV and treatment for chronic hepatitis B or hepatitis C. Medicaid is a state-administered program available to low-income individuals and families who fit into an eligibility group that is recognized by federal and state law. Eligibility for Medicaid and coverage for viral hepatitis services vary from state to state.

State and local (county and city) health departments obtain funds for viral hepatitis prevention and control activities from a variety of sources, including CDC, HRSA, SAMHSA, states, counties, cities, and private foundations. CDC funding supports adult viral hepatitis prevention coordinator (AVHPC) positions in 49 states and five cities (Ward, 2008a). The total funding level is about $5 million per year, and the average award is $90,000. CDC also funds perinatal hepatitis B coordinators in 64 states, cities, and territories at a total program cost of $7.5 million per year (CDC, 2009d). Funding for the AVHPC and perinatal hepatitis B coordinator positions covers only the coordinators’ salaries but not programmatic activities. CDC provides viral hepatitis program support—about $900,000 per year—in the form of grants for viral hepatitis training and education at the state and local levels.

A number of states have developed viral hepatitis prevention plans. At the committee’s request, the Institute of Medicine asked CDC to survey the 55 AVHPCs about the status of their jurisdiction’s plans (CDC, 2009g). All coordinators responded to the questionnaire. Of the 55, 32 (58.2%) indi-



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