Gov’t-Run Health Care Death Sentence in AZ: No More Liver Transplants for Hep-C Patients

By Susan Jones | October 5, 2010 | 10:16 AM EDT

President Barack Obama and Vice President Joe Biden react to cheers as they arrive in the East Room of the White House in Washington, Tuesday, March 23, 2010, for the signing ceremony for the health care bill. (AP Photo/J. Scott Applewhite)

( - Arizona's Medicaid agency will no longer cover some non-experimental organ transplants for its adult members, including liver transplants for patients with Hepatitis C, a move blasted as "a death sentence" by one patient advocacy group.

Medicaid is a federally subsidized, state-administered health-care program for low-income people. Some Medicaid benefits are mandated by the federal government, with states choosing to cover additional benefits.

The federal government spent $275.4 billion on Medicaid in fiscal 2010 and $451.1 billion on Medicare, for a total of $726.5 billion on these two government health-care programs, according to the Office of Management and Budget. By contrast, the federal government spent $692 billion on the U.S. Defense Department in fiscal 2010. 

In a memo announcing a number of benefits changes for adults 21 and older, the state's Medicaid agency said it was responding to "significant fiscal challenges facing the State and substantial growth in the Medicaid population."

As of October 1, the Arizona Health Care Cost Containment System will no longer pay for liver transplants for patients with Hepatitis C; certain heart and bone marrow transplants; or lung and pancreas transplants.

The new transplant exclusions took effect Friday as part of broader Medicaid coverage changes mandated by the State of Arizona in response to budgetary pressures. (Arizona's Fiscal Year 2010 enacted budget directs AHCCCS to eliminate various medical and health services for adults. See page 20 of the bill).

In addition to eliminating most organ-transplant coverage, Arizona's Medicaid agency also is eliminating most dental care for adults as well as coverage of podiatrist services; insulin pumps; percussive vests; bone-anchored hearing aids; cochlear implants; orthotics; gastric bypass surgery; certain durable medical equipment; "well" medical checkups; some non-emergency medical transportation; microprocessor-controlled lower limbs and joints; and it is limiting outpatient physical therapy to 15 visits per contract year. (See list)

A group that advocates for viral hepatitis patients is outraged by the decision to "deprive" hepatitis C patients of liver-transplant coverage, calling the move "cruel" and "inhumane."

The policy change "is effectively a death sentence that, left unchecked, could have far-reaching consequences for millions of Americans afflicted with chronic viral hepatitis," the National Viral Hepatitis Roundtable (NVHR) said on Monday.

It will have "devastating consequences for Arizona's Medicaid beneficiaries," said Lorren Sandt, who chairs the National Viral Heptitis Roundtable. "NVHR recognizes that both public and private health care programs are struggling with the burden of rising costs and a challenging economic environment. However, the cruel costs associated with Arizona's Medicaid coverage changes do not appear to be based on sound science and far exceed any supposed benefit," Sandt added.

Arizona's Medicaid program is the first in the nation to exclude transplant coverage for hepatitis C patients, NVHR said.

One medical expert quoted by NVHR said it is standard practice to give liver transplants to Hepatitis C patients: "All insurance providers -– including state Medicaid programs –- need to provide coverage for what is the standard of care," said Robert G. Gish, M.D., Co-Director of the abdominal transplantation center at the University of California-San Diego School of Medicine. 

According to the federal Centers for Disease Control and Prevention, chronic hepatitis C infection accounts for an estimated 8,000–10,000 deaths each year in the United States, and chronic hepatitis C infection is the leading indication for liver transplants in the United States.

But according to the Arizona Medicaid agency, "The benefits being eliminated or limited are all considered optional services under federal law and therefore, AHCCCS is not required to provide them."

According to NVHR, an estimated 5.3 million Americans have chronic viral hepatitis B or C, but with most of them unaware of their infection, millions of people, especially African Americans and Asian Americans, are at risk of developing life-threatening complications. Without detection and prompt treatment, chronic viral hepatitis leads to liver cancer, cirrhosis, or liver failure. 

NVHR describes itself as a coalition of more than 170 public, private, and voluntary organizations dedicated to reducing the incidence of infection, morbidity, and mortality from chronic viral hepatitis.

The Democrats' new health care law expands Medicaid coverage.

Effective January 1, 2014, Americans who earn less than 133 percent of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100 percent federal funding for the first three years to support the expanded coverage, and 90 percent federal funding in subsequent years, the Health and Human Services Department says.

Medicaid was designed as a jointly funded, federal-state health insurance program for low-income and needy people.