California
lawmaker urges Medicaid programs to change transplant
policies

California assemblyman Paul Koretz on Tuesday called on all state Medicaid programs around the country to change their policies of denying coverage of organ transplants for patients with HIV. An HIV-positive Arizona woman with end-stage liver disease who had been denied transplant coverage by the Arizona Medicaid program recently won her complaint against the government, which Koretz says is a sign that all government-run health plans should heed.

"Across the nation numerous reviews by judges, regulators, legislative committees, internal insurance industry appeal boards, and other deliberative bodies have found that qualified HIV patients should have access to lifesaving organ transplants," Koretz said in a press release. "The Arizona ruling further underscores that the time has come for every Medicaid program in the nation to abandon their outdated perceptions that HIV status alone is grounds for transplant coverage denials."

Koretz authored California bill AB 228--which was enacted in September--that prohibits health plan and insurer denials of transplant coverage based solely on a patient's HIV status. The California Medicaid program, known as Medi-Cal, has no formal policy of denying these patients coverage and recently has been granting coverage on a case-by-case basis. This first step has enabled California Medi-Cal patients to receive the coverage necessary to qualify for the national waiting list for available organs.

Many insurers deny organ transplant coverage for HIV-positive people because of beliefs that HIV patients will not live long enough to fully benefit from the surgeries and that their immune systems cannot handle the immune-suppressing drugs they must take to avoid transplant rejection. However, numerous recent scientific studies have shown that HIV patients with well-controlled virus through antiretroviral therapy fare just as well as HIV-negative transplant recipients.

"I urge all state Medicaid administrators to update coverage policies for organ transplants in patients with HIV," Koretz said. "This is medically necessary care that studies have shown saves lives. To appeal a denial or initiate a special authorization takes time that many of these patients simply don't have." (Advocate.com)