Case Title: Brisson v. Dept. of Social Welfare

Citation: 167 Vt. 148, 702 A.2d 405

Docket Number: 

State: vermont

Court: Vermont Supreme Court

Date: 1997-09-19T00:00:00Z

Document:
Brisson v. Dept. of Social Welfare  (96-427); 167 Vt. 148; 702 A.2d 405

[Filed 19-Sep-1997]

       NOTICE:  This opinion is subject to motions for reargument under
  V.R.A.P. 40 as well as formal revision before publication in the Vermont
  Reports.  Readers are requested to notify the Reporter of Decisions,
  Vermont Supreme Court, 109 State Street, Montpelier, Vermont 05609-0801 of
  any errors in order that corrections may be made before this opinion goes
  to press.

                            No. 96-427

In re Lorraine Brisson                       Supreme Court

                                             On Appeal from Secretary,
                                             Agency of Human Services

                                             April Term, 1997

Cornelius Hogan, Secretary

       Barbara Prine, Vermont Legal Aid, Inc., Burlington, for appellant
  Lorraine Brisson

       Donelle Smith Staley, Assistant Attorney General, Waterbury, for
  appellee Department of Social Welfare

PRESENT:  Gibson, Morse and Johnson, JJ., and Cashman, D.J. and Allen,
          C.J. (Ret.), Specially Assigned

       JOHNSON, J.  Petitioner Lorraine Brisson appeals from the Secretary of
  Human Services's order denying Medicaid funding for a closed-circuit
  television (CCTV).  Brisson argues that a CCTV meets the Medicaid
  definition of "eyeglasses" and that the Secretary's denial of coverage for
  a CCTV is inconsistent with federal Medicaid requirements.  We agree and
  reverse the Secretary's order.

       Brisson applied to the Department of Social Welfare (DSW) for funding
  for a CCTV. The Department denied Medicaid coverage after determining that
  a CCTV does not qualify as durable medical equipment, is not a prosthetic
  device, and is not within the scope of covered vision-care services.  The
  Human Services Board reversed and awarded funding, determining that a CCTV
  is a covered prosthetic device.  The Secretary of Human Services, while
  accepting the Board's findings of fact, reversed the Board's decision and
  denied coverage on the ground that CCTVs are not within the scope of
  covered vision care.  This appeal followed.

       Brisson argues (1) that Vermont has opted to provide Medicaid coverage
  for eyeglasses;

 

       (2) that CCTVs qualify as eyeglasses under the Medicaid Act; and (3)
  that the Secretary's refusal to provide funding for CCTVs as eyeglasses is
  impermissible under federal law.  DSW agrees that providing eyeglasses is
  an optional service, but it argues that the Secretary is entitled to define
  the scope of coverage for optional services.

       Brisson is eligible to receive Medicaid benefits because her age and
  low income entitle her to be classified as "categorically needy."  See 42
  U.S.C. § 1396a(a)(10)(A) (1988).  She lives independently and, among other
  conditions, suffers from macular degeneration, a retinal disorder
  destroying all but her peripheral vision.  She is legally blind and can
  read only if print is magnified to at least eight times its normal size. 
  Her doctors prescribed a CCTV as a medically necessary prosthetic.  She
  uses one currently on loan to help her read medical labels and legal
  documents, follow directions on food preparation, and pay her bills. 
  Without a CCTV, Brisson would need to live in a nursing home or have
  full-time home health care.

       Medicaid is a cooperative enterprise between federal and state
  governments to help states provide health care to people otherwise unable
  to afford it.  See Stevens v. Department of Social Welfare, 159 Vt. 408,
  412-13, 620 A.2d 737, 739 (1992).  The federal government reimburses
  participating states for a percentage of the cost of such care, id. at 413,
  620 A.2d  at 739, and while no state is required to participate in Medicaid,
  those that do must operate in compliance with federal statutory and
  regulatory requirements.  See Alexander v. Choate,