Court Cases

Cunningham v. Birch; Ryan v. Birch (Hepatitis C Treatment Restrictions)

Criminal Legal Reform

Filed: September 19, 2016
Status: Victory!
Court: U.S. District Court for the District of Colorado
Latest Update: Sep 21, 2017

Summary

The ACLU of Colorado filed this class action lawsuit in federal court against the Colorado agency that administers the Medicaid program. It is filed on behalf of thousands of low-income Coloradans suffering from Hepatitis C who have been denied access to life-saving treatment due to Colorado Medicaid restrictions that force them to incur serious harm to their health before gaining access to the cure.

Hepatitis C is a life-threatening, communicable disease that attacks the liver. It is the most deadly infectious disease in the U.S. Breakthrough medications approved by the FDA cure Hepatitis C in more than 90 percent of cases. These treatments are available without restrictions for patients covered by Medicare, the Veterans Administration, and the overwhelming majority of commercial health insurers in Colorado. But for many years, Colorado Medicaid required patients to demonstrate significant scarring on their liver, as indicated by a “fibrosis score” of F3 or higher on a scale of F0 to F4, before gaining access to treatment.

In July 2016, the ACLU of Colorado wrote to the Colorado Department of Healthcare and Policy Financing (HCPF), the agency responsible for setting state Medicaid policy, to urge coverage of all patients regardless of “fibrosis score.” Several month later, the agency modified it policy, but only slightly. It continued to deny treatment on the basis of a fibrosis score. This lawsuit followed.

The court ruled that the ACLU’s original client lacked standing, and the case was refiled with additional plaintiffs in April, 2017. The court then denied Colorado’s motion to dismiss and granted the ACLU's motion for the case to proceed as a class action By the end of the year, Colorado Medicaid rescinded the challenged restrictions on the availability of the life-saving medication.