Pennsylvania Wrong To Deny Medicaid Coverage for Liver Transplant for HIV-Positive Man, Judge Rules

An administrative law judge in Pennsylvania in a decision made public on Wednesday ruled that William Gough, who is HIV-positive, was wrongly denied Medicaid coverage for a liver transplant, 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, was approved as "medically qualified" for a liver transplant in August, but the state officials said that Medicaid could not cover the cost of 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 the 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. 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).