Appellant's Position Statement, Appeal Before the Director of the Arizona Health Care Cost Containment System, Lambda Legal

Pleadings and Briefs

Community Legal Services, Inc. and Lambda Legal filed an appeal on behalf of the appellant, a woman living with HIV who was denied coverage for her liver transplant by Arizona’s Medicaid program (AHCCCS). AHCCCS refused to cover transplants for individuals living with HIV, claiming that HIV was a contraindication for transplantation, a treatment it considered “experimental.”

This brief argues that the AHCCCS violated federal and Arizona law by arbitrarily denying coverage for a medically necessary, non-experimental transplant. It argues that the AHCCCS relied on broad generalizations about HIV when scientific and medical evidence showed that the appellant was, in fact, a strong candidate for a liver transplant. It supports this argument with testimony from the appellant’s physician, medical literature, and other expert opinions demonstrating that the appellant was a strong candidate for transplantation and that her HIV would not harm the success of the transplantation. It also cites medical research and advances in HIV treatment and organ transplantation, as well as decisions of other state Medicaid programs, federal health care providers, and state legislation that recognize that organ transplantation should not be denied based on HIV status alone. The brief also argues AHCCCS violated Title II of the Americans with Disabilities Act and the Rehabilitation Act by basing its denial of benefits solely on the appellant’s HIV status.

The Director of the AHCCCS subsequently overturned the denial of coverage in a decision available on the Resource Bank here.