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Representing Plaintiff(s) · Victory · Final Disposition on January 1, 2001

Doe v. Managed Care Organization

In the first legal ruling of its kind in the country, GLAD prevailed in an action to cover the cost of a life-saving liver transplant for a Medicaid recipient with both HIV and end-stage liver disease as a result of hepatitis C. The case was brought on behalf of a 41 year-old Roxbury, MA man who was in no danger of dying from his HIV, but would have died within months of Hepatitis-related liver disease without the transplant. Medicaid coverage was denied on the ground that liver transplants are “experimental” – and, therefore, are not covered – in the presence of HIV infection. On appeal, the Division of Medical Assistance Board of Hearings rejected the claim that liver transplantation is “experimental” in people with HIV. As a result of this decision, insurers cannot categorically exclude people with HIV from liver transplantation.