Groups Appeal Pennsylvania Medicaid Decision To Not Cover Liver Transplant for HIV-Positive Man

Lawyers representing an HIV-positive man during a hearing on Wednesday in front of an administrative law judge said there is no evidence that "otherwise healthy" HIV-positive patients have a reduced survival risk for organ transplants and argued that the Pennsylvania Medicaid program should cover a liver transplant for their client, the AP/Harrisburg Patriot News reports (Schlesinger, AP/Harrisburg Patriot News, 11/20). Lawyers from the Lamda Legal Defense and Education Fund and the AIDS Law Project of Pennsylvania, who are representing 46-year-old William Gough, are appealing the state Medicaid program's decision to not cover Gough's liver transplant. Gough, who was diagnosed with hepatitis C the same year he was diagnosed with HIV, said that his hepatitis-C-related liver problems significantly progressed last year, according to the AP/Fort Worth Star-Telegram. He was approved as "medically qualified" for a liver transplant in August, but the state Medicaid program said that it could not cover the transplant because liver transplants in HIV-positive people are "experimental" and because the procedure was "not medically necessary," Hayley Gorenberg, AIDS project director at Lamda Legal, said, according to the AP/Star-Telegram (Schlesinger, AP/Fort Worth Star-Telegram, 11/20). Medicaid officials during a telephone hearing with the judge on Wednesday said that the program does not cover transplants for people who have other life-threatening conditions, the Pittsburgh Post-Gazette reports (Srikameswaran, Pittsburgh Post-Gazette, 11/21).

Expedited Ruling
Gough's attorneys asked the judge to expedite a decision because Gough may not be healthy enough to undergo a transplant if he waits much longer, Gorenberg said. "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 said. Stephanie Suran, a spokesperson for the Pennsylvania Department of Public Welfare, which oversees the state's Medicaid program, said that the department would not comment on the case until the judge makes a decision, which is not expected until next month, the AP/Star-Telegram reports. Gough said that he sees his case as a step in creating a better insurance system, adding, "If I don't live long enough to receive a liver transplant, someone behind me will benefit from my actions, my fight" (AP/Fort Worth Star-Telegram, 11/20).