Justia Vermont Supreme Court Opinion Summaries

K.M., an adult with multiple disabilities, including autism and a seizure disorder, has been receiving Medicaid-funded developmental disabilities services for over twenty years. These services, provided by Washington County Mental Health Services (WCMHS), were supposed to include more than thirty hours of community support each week. However, since March 2020, K.M. has only received two to five hours of support weekly, leading to negative health effects.K.M. petitioned the Human Services Board to order the Department of Disabilities, Aging, and Independent Living (DAIL) to provide the full services he is entitled to. The Board dismissed his petition, stating it failed to specify the action required for compliance and that an order to provide services without available staff was too vague. The Board also interpreted K.M.'s request as seeking a broader policy change, which it deemed outside its authority, citing Husrefovich v. Department of Aging & Independent Living.The Vermont Supreme Court reviewed the case and reversed the Board's dismissal. The Court held that the Board has the statutory authority to order DAIL to provide the services K.M. is entitled to under federal and state law. The Court clarified that while the Board cannot issue broad policy injunctions, it can provide specific relief to individuals. The Court found K.M.'s request for services clear and specific enough to inform DAIL of the required action. The case was remanded to the Board for further proceedings consistent with this opinion. View "In re Appeal of K.M." on Justia Law

Jason Lillie appeals the Employment Security Board’s denial of his claim for unemployment benefits. In July 2014, Lillie was an employee of Amerigas Propane, Inc. and suffered an injury while working. He reported the injury to his employer, which in turn reported it to its worker’s compensation insurer. He sought medical attention for his injury shortly after being hurt but was able to continue working for several weeks, most of it on modified or light duty. In October, Amerigas fired Lillie for an alleged safety violation. A few days later, Lillie’s doctor indicated he was medically unable to work. Lillie expressed concern that he was ineligible for unemployment benefits because he was not able to work but was told he must apply in order to receive economic benefits. Lillie then sought workers’ compensation temporary disability benefits, which were initially denied by the insurer. Without any income or compensation disability benefits for several weeks, Lillie sought economic assistance from the Vermont Economic Services Division of the Department for Children and Families. Lillie was told by Economic Services that in order to be eligible for economic assistance he would have to file for unemployment benefits, even if he felt he would not qualify for them. With his workers’ compensation claim still in dispute, and based upon the information he had received from Economic Services, Lillie filed a claim for unemployment benefits. The Unemployment Division found him to be monetarily eligible for unemployment benefits when he sought them in December 2014. While he had the necessary base period wages to make him monetarily eligible for benefits, Lillie was not able to work and available for work, as required by 21 V.S.A. 1343(a)(3), because he was medically unable to work. He was, therefore, denied unemployment compensation. "At a minimum, coordination of the important information between the Unemployment Division and Economic Services concerning monetary eligibility, the establishment of a benefit year, and the use of wages and the use of wages prior to disability in connection therewith in the case of a worker injured on the job may have avoided this quagmire. Following the advice given by Economic Services, which we do not doubt was provided in good faith to Lillie, resulted in the unintended consequence of his loss of unemployment benefits once he regained his ability to work in 2017." The Vermont Supreme Court affirmed the denial of unemployment benefits; the Unemployment Division applied the law properly, and the Court was "not at liberty to rewrite the applicable statutes to obtain a different outcome." View "Lillie v. Department of Labor" on Justia Law

This case focused on whether the Department for Children and Families (DCF) could deny an applicant temporary housing assistance under General Assistance (GA) Rule 2652.3 for having left her housing in response to a notice of termination without cause from her landlord. DCF argued that applicant Dezarae Durkee caused her own loss of housing and therefore was ineligible for assistance. The Human Services Board upheld this determination. Applicant argued that leaving in response to a notice of termination without cause does not constitute causing her own lack of housing and sought a declaration of such damages. The Vermont Supreme Court granted the declaratory judgment but concluded damages were not appropriate relief. View "In re Appeal of Dezarae Durkee" on Justia Law

Petitioner was admitted to a nursing home in September 2010. She was eighty-seven years old at the time, and had a diagnosis of dementia and Alzheimer's disease. Petitioner's adult daughter, who had the authority to act on petitioner's behalf by virtue of a power of attorney, submitted an application for long-term care Medicaid benefits in January 2011. The application sought coverage for petitioner, retroactive to October 1, 2010, pursuant to a Medicaid rule authorizing benefits for up to three months preceding the month of application. A benefits specialist with the Department for Children and Families testified that, in response to the application, she sent two separate verification requests to petitioner's daughter and an administrator at petitioner's nursing home. The Department received no response to these requests. Accordingly, in March 2011, the Department issued a Notice of Decision ("Notice") denying the application. No appeal of the denial was filed by petitioner or a person acting on her behalf within the ninety-day limit. Petitioner's daughter would submit a total of four applications, each with a request from the Department for additional information, and each time, no information was provided, and the applications were denied. With the assistance of her son, petitioner filed a fifth application for benefits in February 2012. This time, additional information verifying petitioner's financial eligibility was provided, and the application was approved by the Department in May 2012 with benefits retroactive to November 2011, which was three months prior to the date of the fifth and final application. Petitioner appealed that decision, seeking coverage retroactive to October 2010, which would have been three months prior to her first application from January 2011. An evidentiary hearing was held in July 2013 before a Department hearing officer. The Board adopted the hearing officer's findings and issued a decision reversing the Department's decision to limit retroactive benefits to November 2011. The Board concluded that, for reasons of equitable estoppel, petitioner could be awarded benefits retroactive to October 1, 2010 based on the date of the initial application. The Department sought review by the Secretary, who reversed the Board's decision. Because petitioner did not respond to the Department's multiple requests for verification, did not advise the Department of any valid reasons for failing to respond, and informed the Department's benefits specialist that the failure to respond was her responsibility, that she had "dropped the ball." Accordingly, the Secretary found no justification to invoke the doctrine of equitable estoppel, and reversed the Board's decision. Finding no reversible error, the Vermont Supreme Court affirmed the Secretary's reversal of the Board's ruling. View "In re Bernice Landry" on Justia Law

In consolidated appeals, petitioners, both recipients of home-based long-term care benefits through Vermont's Medicaid-funded Choices for Care (Choices) program, appealed decisions of the Human Services Board disallowing deductions for personal care services from their patient-share obligation under federal and state Medicaid laws. Upon review of the cases, the Supreme Court concluded that to the extent the services in question were medically necessary, expenses for those services must be deducted from petitioners’ patient-share obligation even if they are of a type generally covered by Medicaid. Furthermore, the Court rejected the State’s claim that the decision of the Department of Disabilities, Aging and Independent Living not to provide the personal care services in question under the Choices program constituted a conclusive finding that the services were not medically necessary. View "In re Brett" on Justia Law

Employer Maple Leaf Farm Association, Inc. appealed a decision of the Employment Security Board finding that its former employee Katherine Kelley was involuntarily terminated from her position and therefore eligible for unemployment compensation benefits. Employer operated an intensive inpatient drug and alcohol treatment program. Claimant worked for employer as a part-time treatment counselor for seven years. Due to a conflict with a supervisor, claimant resigned from her position in writing on August 29, 2013. She stated in her letter to employer that her last day would be September 19, 2013, and employer allowed her to continue working. Four days later, on September 3, employer terminated her employment and escorted her off the premises. Claimant applied for unemployment compensation. The claims adjudicator determined that she was not entitled to benefits for the first two weeks after her termination because the accrued vacation pay that employer paid her during that period was in excess of her weekly benefit amount. The claims adjudicator further determined that claimant was not entitled to benefits because she had left employment voluntarily without good cause attributable to her employer. Employer appealed the referee’s decision to the Employment Security Board, which adopted the referee’s findings and affirmed its conclusions. Finding no reversible error, the Supreme Court affirmed the Board's decision. View "Kelley v. Department of Labor" on Justia Law

Applicant Marilyn Clifford appealed the denial of long-term home-care benefits under the Medicaid-funded Choices for Care program, arguing that a second home on an adjacent piece of property should have been excluded from the financial-eligibility calculation. Given the language of the regulation, the legislative history that led to its promulgation, and the policy considerations attending the Medicaid program, the Supreme Court concluded that the Secretary correctly interpreted the home-exclusion rule when he reinstated the determination of the Department of Children and Families denying the benefits. Thus, the Court found no compelling indication of error in the Secretary’s determination and affirmed. View "In re Marilyn Clifford" on Justia Law

Medicaid recipient John Doe and the State appealed a trial court's decision allowing the State to partially recover the amount of its lien against Doe's settlement with a third party. In 1992 when Doe was nine years old, he was catastrophically injured and paralyzed in an automobile accident.  Due to Doe's injuries, his mother applied for Medicaid on his behalf in 1994.  Doe later brought suit in New York Supreme Court against the alleged third-party tortfeasors.  He also sued New York State Transit Authority (NYSTA) in the New York Court of Claims.  The State of Vermont notified Doe in January 2001 that it claimed a lien against any award, judgment, or settlement stemming from the accident.  In 2001, Doe settled the lawsuit against the third parties for $8.75 million. Doe's suit against NYSTA went to trial, and in 2004, the Court of Claims awarded Doe approximately $42 million and allocated approximately $2.9 million to Doe's past medical expenses from the date of injury to the date of trial. Between the 2001 and 2006 settlements, the State paid approximately $771,111 in medical expenses for Doe's care, in addition to the medical expenses paid up to the date of the first settlement.  The State claimed a lien on the 2006 settlement for $506,810, which was the difference between the amount the State paid for Doe's medical care under Medicaid and the State's share of litigation expenses. Doe sued the State of Vermont, seeking a declaratory judgment that he satisfied the State's lien by partial payment.  On summary judgment, the court concluded that it would not undo the 2001 settlement because it was an accord and satisfaction of all claims paid for medical expenses incurred to that point in time. The State argued on appeal to the Supreme Court that the trial court should have reduced the Court of Claims' findings of future economic damages to present value before making its lien allocation. Upon review, the Supreme Court concluded the parties' agreement resolved the issues surrounding the State's lien on Doe's first settlement, while leaving open the possibility that Doe would obtain a judgment against or settlement with the NYSTA.. On these facts, the Court agreed with the trial court that there was an accord and satisfaction, and that the State accepted $594,209.03. The case was reversed and remanded to recalculate the State's lien against $771,111 in medical expenses and reasonable attorney's fees, but affirmed in all other respects.  View "Doe v. Vermont Office of Health Access" on Justia Law

Claimant Katherine St. Martin appealed the Employment Security Board's determination that she voluntarily left her job without good cause, disqualifying her from receiving unemployment benefits. She argued on appeal that her decision to quit her job was with good cause because she reasonably believed she would not receive a paycheck for her work. Claimant worked for almost two years for her employer as an assistant financial supervisor, which required her to prepare payroll information weekly. At some point, her employer began to have financial difficulties, and the payroll submission day was moved back to later in the week. The president of Claimant’s employer told claimant not to submit payroll because there were inadequate funds to cover the checks. The president then attempted to borrow money to meet the payroll, which ultimately proved "fruitless." The chief of operations persuaded the president to close the business and pay the employees. Claimant submitted the payroll after being given permission to do so by the president. She then printed the checks, and distributed them to the employees. After the president told claimant that the checks would bounce due to lack of funds, Claimant quit. Upon review, the Supreme Court held that Claimant should not have been penalized for leaving her job when she was told not to expect a paycheck. The president's statement amounted to "good cause." View "St. Martin v. Dept. of Labor" on Justia Law

Respondent Alan Cote appealed a family court's garnishment order that directed the Social Security Administration to withhold his Social Security benefits to offset alimony arrearages. On appeal, Respondent contended that the garnishment order violated a provision of the Federal Consumer Credit Protection Act which imposes a cap on the percentage of aggregate disposable earnings that any court, state or federal, may garnish. While the trial court garnished only Respondent's Social Security disability benefits and not his veterans' disability benefits, the court did include the latter in its calculation of aggregate disposable earnings.  This broad calculation of disposable earning increased the percentage of Respondent's Social Security payments subject to garnishment.  Respondent contended that as defined and excluded from such a calculation by federal law, his particular veterans' disability benefits were not to be counted as earnings because they were not paid for a service related disability and are not received in lieu of retirement payments to which he would otherwise be entitled as earnings.  Upon review of the lower court's record and calculations, the Supreme Court agreed, reversed the lower court's order and remanded the case for recalculation of the garnishment. View "Cote v. Cote" on Justia Law