The state Health Department will stop all Medicaid-funded transplants except liver, kidney and cornea, effective immediately.
U.S. District Judge J. Thomas Greene ruled Wednesday that Utah cannot provide transplants for children and deny those same procedures to adults. On Thursday, the assistant attorney general Douglas W. Springmeyer said the state is crafting an emergency ruling that would ban all but the three transplant procedures for any Medicaid recipient, regardless of age. As soon as it's written, it will go into effect - most likely by Friday afternoon.Members of the Medical Care Advisory Committee, which recommends policy to the Health Department, expressed concern about not providing potentially lifesaving bone marrow, heart and multiple-organ transplants to low-income children. And they appointed a subcommittee to study whether the transplants can be funded somehow.
The issue is money. The Medicaid budget, which is provided by matching federal and state funds, doesn't have the estimated $11 million it would cost to provide the full range of transplants to both adults and children.
The change won't affect any transplants for children that have already been authorized by Medicaid. Because the emergency rule is only good for 120 days, the state will have to hold a public hearing to extend the change beyond that.
The decision is financially necessary right now, said Michael Deily, director of Health Care Financing, which administers Medicaid. But it doesn't make anyone happy.
"We are open to alternatives to make up the shortfall," he said. "We are taking this course in large part because we have had previous discussions (about funding transplants). We would be interested in hearing from MCAC (the advisory board) if it would like us to look at something else."
Kent Ronier, speaking for the Health Department, said as many as 20 children might be denied the transplants in a year.
"I think this is a major issue," said MCAC chairman Dale Gunnell. "We had no advance time to think about it. I hope that (the fact) there's not more enthusiasm to jump up and down on the table is not indicative of a lack of interest."
The judge's ruling came during an emergency hearing on behalf of Alice McDaniel, a 22-year-old woman who has stage III Hodgkins lymphoma. She was denied a bone-marrow transplant because the procedure has only been covered for people up to age 21.