November, 2001
GLAD WINS LANDMARK LEGAL VICTORY ORDERING COVERAGE OF LIVER TRANSPLANTS FOR PEOPLE WITH HIV

(Boston, MA)  In the first legal ruling of its kind in the country, the state Medicaid agency has ordered that Neighborhood Health Plan (NHP) cover the cost of a life-saving liver transplant for a  patient who has both HIV and end-stage liver disease resulting from Hepatitis C Virus (HCV).  NHP is the same HMO which in July denied a liver transplant to AIDS Activist Belynda Dunn solely because of her HIV-positive status.

NHP, along with providing private health insurance to individuals such as Ms. Dunn, provides health care to Medicaid (now called MassHealth) recipients in Massachusetts through a contract with the state.  This ruling covers Medicaid recipients in Massachusetts.

 The legal action was brought by Gay & Lesbian Advocates & Defenders, a Boston-based legal organization, on behalf of a 41 year-old life-long resident of Roxbury, MA who is in no danger of dying from his HIV, but will die within months from HCV-related liver disease unless he receives a transplant.

In its decision, the Division of Medical Assistance Board of Hearings rejected NHP’s determination that liver transplantation is “experimental” in people with HIV.  The Board of Hearings ruled that there may be no categorical exclusion of HIV-positive individuals from liver transplantation.

 According to GLAD attorney Bennett H. Klein, who represented the MassHealth patient in the case, “Today’s decision breaks through the barriers which insurers have erected to exclude people with HIV from life-saving transplants.  With today’s decision, HMOs are required to prioritize medical care rather than the bottom line.” Klein added: “Today, people with HIV live long lives.  But all of the improved treatments for HIV will mean nothing if HMOs and insurers can allow people to die from other immediately life-threatening conditions.”

 “It is not acceptable that an HMO can deny people with HIV and Hepatitis C life-saving care,” says Larry Kessler, Executive Director of AIDS Action Committee, which together with GLAD has long advocated for equal access to health care for people with HIV.  “This decision means that MassHealth members in Massachusetts may not be subjected to substandard care.”

 The Hepatitis C Virus causes potentially fatal liver disease, liver cancer and liver failure.  For people with HIV, co-infection with Hepatitis C is especially dangerous since many HIV drugs worsen the liver damage caused by Hepatitis C.  Many people infected with Hepatitis C suffer such severe liver damage that a transplant offers the only hope of survival.

 Gay & Lesbian Advocates & Defenders (GLAD) is New England’s leading public interest legal organization working in the courts to fight discrimination on the basis of sexual orientation, HIV status, and gender expression and identity.

 AIDS Action Committee of  Massachusetts, New England’s leading AIDS service, education and advocacy oranization, provides free, confidential services to more than 2,300 men, women and children living with HIV and AIDS. For more information, visit www.aac.org.