BOSTON (AP) - A state board ruled Wednesday that an
HIV-positive man with end-stage liver disease should be covered
by Medicaid for a potentially life-saving liver transplant.
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
"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
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
NHP Director of Corporate Communications Deborah Reiter said
the company was reviewing the ruling but had no immediate