## Facts

- The Office of Vermont Health Access (OVHA) administered Vermont’s Medicaid program and, by regulation, covered only transportation to and from **necessary** medical services.
- OVHA’s transportation rules excluded payment for “exceptionally expensive transportation” and for transportation to a Medicaid recipient’s preferred provider when an adequate alternative was available.
- In 2003, Lisa Green, a Vermont Medicaid recipient with heroin addiction, began methadone treatment at a clinic in Greenfield, Massachusetts because there were not comparable treatment services near her home in Vermont.
- About two years later, a new methadone treatment program became available in northern Vermont, closer to Green’s residence.
- OVHA notified Green that Medicaid would no longer pay for transportation to the Massachusetts clinic because closer treatment services were now available in Vermont.
- Green petitioned to maintain Medicaid payment for transportation to the Greenfield clinic.
- Green submitted two letters from care providers stating that transferring her from the Greenfield program would negatively affect her health.
- The letters emphasized that removing Green from the women’s group she attended at the Greenfield clinic would lead to emotional and physical health problems.
- OVHA responded that multiple programs in northwestern Vermont offered treatment in women’s group settings and that the services provided at the Greenfield clinic were available in some form at Vermont locations.
- The Human Services Board granted Green’s petition, reasoning OVHA had not contradicted the providers’ statements about harm from a transfer.
- OVHA appealed within the Agency of Human Services, and the Secretary reversed the Board, determining the providers’ assertions of harm from transferring Green to a Vermont clinic were not supported.
- Green appealed the Secretary’s decision to the Vermont Supreme Court.

## Issues

1. Under OVHA’s Medicaid transportation regulations, could OVHA discontinue payment for transportation to an out-of-state methadone clinic once a closer in-state program became available?
2. In the agency review process, did the Secretary of the Agency of Human Services have authority to reverse the Human Services Board’s decision granting continued transportation coverage?
3. On judicial review, was the Secretary’s decision supported by the record and consistent with the governing Medicaid transportation rules?

## Decision

- The Vermont Supreme Court upheld the Secretary’s decision reversing the Human Services Board.
- The court left in place OVHA’s determination to stop paying for transportation to the Greenfield, Massachusetts methadone clinic after nearer in-state services became available.

## Legal Principles

- Medicaid transportation benefits may be limited by regulation to transportation to and from medically necessary services.
- A Medicaid agency may deny transportation that is exceptionally expensive or that seeks access to a preferred provider, when comparable covered services are available closer to the recipient.
- When an agency’s transportation rules focus on medical necessity, evidence offered to justify a more distant provider must support a medical need for that specific provider or location, not simply a preference for continuity or program features.
- In administrative review, the final decisionmaker may reverse an intermediate board when the board’s outcome rests on assertions the final decisionmaker finds unsupported by the record.
- On judicial review of final agency action, the court will sustain the agency’s decision when it is consistent with the applicable regulations and supported by evidence in the administrative record.

## Conclusion

In re Green, 2006 WL 5838948 (Vt. 2006), involved a Medicaid recipient who sought continued payment for transportation to an out-of-state methadone clinic after a closer Vermont program became available; although the Human Services Board ordered continued coverage based on provider letters warning of harm from transferring care, the Secretary reversed as unsupported, and the Vermont Supreme Court sustained the Secretary’s final administrative decision, allowing OVHA to end payment for travel to the Massachusetts clinic.


In re Green, 2006 WL 5838948 (2006)