Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
Associated Press - Wednesday November 14, 2001
Justin Pope, AP Business Writer
The Division of Medical Assistance Board of Appeals said the procedure was "medically necessary" and not experimental. Some scientists believe that HIV reduces the chance of survival for transplant patients.
"Certainly, for all Medicaid recipients, HIV status alone can no longer be a basis to refuse liver transplantation," said attorney Bennett Klein of Gays and Lesbian Advocates and Defenders. "This decision really breaks new ground."
The ruling would only directly affect Massachusetts Medicaid recipients in similar circumstances. But, Klein said, the ruling could help make the case in other states and with private insurance companies.
HIV drugs have kept the patient from developing AIDS, but he also has hepatitis C and is expected to die of liver failure within months. The man wasn't identified, but is 41 years old and lives in Boston.
The ruling granted his request for a referral to the University of Pittsburgh transplant program. It also ordered Neighborhood Health Plan, a private company that provides health care to Medicaid recipients through a state contract, to pay for the procedure.
The man still could be denied a transplant for medical reasons. The state Division of Medical Assistance insisted the decision would not apply to all cases.
"It's not a blanket approval that all people with HIV would be automatic candidates for a transplant," spokesman Richard McGreal said. "Just because this person fits the medical necessity definition, and is approved for a liver transplant, the next person who comes along may be totally different."
NHP was involved in a similar dispute last summer when a woman who also had HIV and hepatitis and needed a liver transplant sued to force it to change its policies.
A different state panel ruled against Belynda Dunn, but she withdrew her lawsuit after receiving $100,000 in donations from the HMO and private givers to pay for the procedure.
In the latest case, the board queried experts in the field on the efficacy of liver transplants for patients with HIV and concluded that recent advances in AIDS treatment indicated "the treatment will be effective in light of his specific clinical picture."
NHP Director of Corporate Communications Deborah Reiter said the company was reviewing the ruling but had no immediate comment.
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