Pennsylvania: HIV-Positive Man Appeals State Medicaid Denial of Transplant Coverage
November 20, 2003
Attorneys for an HIV-positive man said Pennsylvania's Medicaid program should cover his liver transplant because there is no evidence that otherwise healthy HIV-infected patients have a worse chance of organ transplant survival than those who are not HIV-infected. William Jean Gough was denied coverage by the state's Medicaid program for the transplant, and attorneys for Lambda Legal and the AIDS Law Project of Pennsylvania are appealing the decision.Adapted from:
In a hearing conducted Wednesday, attorneys asked the administrative law judge to expedite a decision because Gough -- who was diagnosed with hepatitis C the same year he was diagnosed with HIV -- might not be healthy enough to undergo a liver transplant if he waits much longer, said Hayley Gorenberg, AIDS Project director at Lambda Legal. "There have been similar cases in other states where, by the time a decision to not cover a transplant has been overturned, the patient is too sick to go through the transplant or dies," Gorenberg noted.
In August, Gough was deemed medically qualified for the transplant. Gough said he does not suffer from disabling HIV symptoms. Medicaid officials told Gough the state program could not cover his transplant because the surgery is experimental and not medically necessary, said Gorenberg.
But at Wednesday's hearing, attorneys for the state argued the program cannot cover transplants for patients who have other life-threatening conditions, according to Gorenberg.
In October, Kaiser Permanente, one the largest U.S. health maintenance organizations, reversed an earlier decision and approved a kidney transplant for a HIV-infected Denver man.
Gough believes cases appealing to insurers to cover transplants for HIV-infected patients are necessary steps in creating a better insurance system. "If I don't live long enough to receive a liver transplant, someone behind me will benefit from my actions, my fight," he said.
The judge is not likely to rule on the case until December.
11.20.03; Allison Schlesinger
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.