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program in the nation to abandon their outdated perceptions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)