Drugs that can cure hepatitis C virus (HCV) in as little as 8 to 12 weeks have been available for nearly five years. The drugs are expensive, though, which is why many state Medicaid programs initially restricted coverage for only the sickest patients. But with the advent of new drugs for HCV and decreasing prices that has changed in many states. But in Puerto Rico, Medicaid patients continue to receive no coverage for HCV drugs. To find out why, Kaiser Health News recently investigated.

Currently, Puerto Rico’s joint federal-territory health care program for the poor, which covers about 50 percent of the island’s population, does not pay for hepatitis C treatment. It doesn’t cover liver transplants for sick patients either, which leaves thousands without care or a chance of survival. In 2015, the U.S. territory launched a pilot project to provide treatment to those with HCV and HIV. Although that program was later expanded to include those with only hepatitis C, the island’s Office of Patient Legal Services say the program has run out of funding and is no longer accepting patients unless they have both viruses.

Meanwhile, it is estimated that 2.3 percent of residents ages 21 to 64 years old are living with hepatitis C (compared with an infection rate of about 1 percent stateside). The Center for Health Law and Policy Innovation at Harvard Law School reported that more than 11,000 people tested positive for HCV on the island between 2010 and 2016. But because the disease often causes no symptoms and recent data is lacking, the true number of Puerto Ricans living with the virus remains uncertain.

Puerto Rico also has fewer resources than most states to care for sick people below the poverty line. Unlike states, Puerto Rico’s federal funding for Medicaid is capped, and advocates say these dollars regularly fall short of covering the cost of medical care. In fact, the territory’s incredible Medicaid expenses helped driver Puerto Rico’s $70 billion debt crisis.

In response, health workers on the ground in Puerto Rico are talking with pharmaceutical companies to create a network separate from the island’s Medicaid program to provide hepatitis C treatment to sick patients. But thus far, no agreements have been made.