Fla. Health Officials to Correct Criteria on Hepatitis C Treatment

Fla. Health Officials to Correct Criteria on Hepatitis C Treatment

Legal Groups Representing Palm Beach County Woman Force Agency to Revise Action

Washington – The Florida Agency for Health Care Administration announced Friday that it is taking corrective measures to ensure that state Medicaid recipients will have proper and timely access to Hepatitis C (HCV) treatment, including coverage of Direct-Acting Antiretrovirals. Florida was spurred to change course after the Florida Legal Services, Inc., Legal Aid Society of Palm Beach County, Inc., and the National Health Law Program (NHeLP) discovered that the Florida health agency’s policies were violating patients’ rights pursuant to the Medicaid Act.

In summer 2015 Molina Healthcare, a Medicaid plan, denied Vickie Goldstein, a Palm Beach County resident, access to a Viekira Pak, a Direct-Acting Antiretroviral drug used to treat HCV. Ms. Goldstein’s denial notice stated the medication was “not medically necessary.” She appealed the denial, and in fall 2015 Molina denied the appeal, again stating that the treatment was not a “medical necessity.” Representing Ms. Goldstein, Florida Legal Services, NHeLP, and the Palm Beach County Legal Aid Society discovered that Florida Medicaid and Molina were not adhering to the standard care for treating HCV, and they were violating Ms. Goldstein’s and other Medicaid beneficiaries’ rights under the Medicaid Act. In April the groups demanded that Florida amend its criteria for dispensing HCV treatment and medications to fall in line with standard practice and federal Medicaid guidelines, provide new forms for HCV drugs on its website and alert all medical providers enrolled in the Medicaid program to the new criteria. Florida announced Friday that it will meet these demands. Managed care plans will have until June 17 to comply with the new policy.

Ms. Goldstein said that without legal intervention she may not have been able to access the potentially life-saving medication.

“Despite the fact that there is a cure for this infectious disease, too many people have died because they had no access to the treatment,” Ms. Goldstein said. “Now, this will start to change in Florida because we have shined a spotlight on the barriers to access treatment for this disease. I was so fortunate to have these amazing lawyers working tirelessly on this case and this issue to right a horrible injustice.”

NHeLP Staff Attorney Abbi Coursolle said Florida’s corrective measures will put other states on notice that they run afoul of Medicaid law by improperly denying patients’ access to HCV treatment.

“Sadly this is not an isolated incident, too many state Medicaid programs are not meeting minimum federal requirements for providing hepatitis C treatment,” Coursolle said. “A recent congressional report found that 25 states limit access to treatment until the disease has progressed to advanced stages. More work remains to be done to ensure all Medicaid beneficiaries regardless of where they reside are not denied quality health care.”

Miriam Harmatz, a senior attorney at Florida Legal Services and a member NHeLP’s Board of Directors, said Florida’s guidelines were unduly causing harm to Medicaid beneficiaries.

“No one suffering from a serious, but now curable disease, should be forced to go through what Vickie Goldstein has had to endure,” Harmatz said. “As we noted in our correspondence with Florida, a large number of Medicaid beneficiaries with HCV are either not receiving medically necessary treatment or their treatment is being improperly delayed. The Florida Medicaid Agency should be commended for this policy change which will ensure that all beneficiaries with hepatitis C can receive medically necessary medication.”

Vicki Tucci Krusel, supervising attorney for the Legal Aid Society of Palm Beach County’s Coverage to Care Legal Initiative, said, “We hope that Vickie’s story will inspire Medicaid beneficiaries in other states to seek legal help if they are being denied access to HCV treatment. Vickie’s life and many other lives will be improved by these corrective steps. Starting today, Florida will no longer wrongfully deny Medicaid beneficiaries life-saving and curative treatment for hepatitis C.”

Founded in 1969 NHeLP advocates for the rights of low-income and underserved people to access quality health care.

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