Judge Overturns Pennsylvania Medicaid Decision Not To Cover Liver Transplant for HIV-Positive Man

An administrative law judge in Pennsylvania in a decision made public on Wednesday ruled that William Gough, who is HIV-positive, was wrongly denied coverage for a liver transplant under the state's Medicaid program, the AP/Philadelphia Inquirer reports (Sheehan, AP/Philadelphia Inquirer, 12/11). 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. 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 considered experimental and because the procedure was "not medically necessary," Hayley Gorenberg, AIDS project director at Lamda Legal Defense and Education Fund, said. Lawyers from Lamda Legal and the AIDS Law Project of Pennsylvania, who represented Gough, appealed Medicaid's decision (Kaiser Daily HIV/AIDS Report, 11/24). Judge Bernadene Kennedy expedited her ruling because Gough's condition is worsening and because he would become ineligible for the transplant if his liver continues to deteriorate. Kennedy in her ruling said that scientific advances now allow HIV-positive people to live "full lives," according to the AP/Philadelphia Inquirer. State Department of Public Welfare spokesperson Stephanie Suran said that the department will not appeal the ruling (AP/Philadelphia Inquirer, 12/11). Gorenberg said that Gough soon will be put on a waiting list for the transplant. "The state was responsive to logic and evidence and science at this appeals level," Gorenberg said, adding, "The big battle is to create policies and practices that are clear enough that we don't have to keep fighting these cases individually" (Srikameswaran, Pittsburgh Post-Gazette, 12/11).