In re Green

Under Office of Vermont Health Access (OVHA) (defendant) regulations, Medicaid coverage extended only to transportation to and from necessary medical services and not to costs for exceptionally expensive transportation or to an individual’s preferred provider. In 2003, Lisa Green (plaintiff), a heroin addict, sought treatment at a methadone clinic in Greenfield, Massachusetts, because of the unavailability of treatment services nearby Green’s home in Vermont. Two years after Green had started treatment, a new program was offered in northern Vermont, closer to Green’s residence. OVHA notified Green that the cost of transportation to the Massachusetts clinic would no longer be covered by Medicaid due to the availability of closer services. Green petitioned to maintain coverage of the cost of transportation services to the Greenfield clinic. Green submitted two letters from her care providers in support of the petition, with each provider indicating that the transfer away from services in Greenfield would negatively affect Green’s health. Specifically, the letters stated that removing Green from the women’s group in which she participated would result in emotional and physical health problems. OVHA argued that a number of programs in northwestern Vermont offered treatment in women’s group settings and that all services available at the Greenfield clinic were available in some form at Vermont locations. The Human Services Board (the board) granted Green’s petition, finding that OVHA failed to contradict the providers’ statements about the negative effects on Green’s health if she were forced to transfer from the Greenfield location. OVHA appealed, and the secretary of the Agency of Human Services (the secretary) reversed the board’s order, determining that the providers’ assertions that transferring Green to a Vermont clinic would cause harm were not supported. Green appealed.