Valley Vista, Vermont’s largest substance use disorder rehabilitation facility, will no longer take patients on methadone, an administrator said Thursday.

The facility, which has locations in Bradford and Vergennes, will continue to serve current patients who are on methadone, Kevin Hamel, Valley Vista’s vice president of medical and clinical services, told facility staff in an email Thursday morning. But Valley Vista will no longer accept new patients who use the recovery drug, he said.

In an interview, Hamel said Valley Vista currently has seven patients on methadone, out of a total of 78, across both of its locations. Transporting those patients to and from methadone clinics can cost up to $400 a day, Hamel said, a sum the facility can no longer afford.

“The cost of staffing is going up,” he said. “The cost for us to be able to provide health insurance for employees is significantly going up this year.”

Methadone is a drug used to mitigate withdrawal symptoms in people recovering from substance use disorder. The drug, which usually comes in the form of a drinkable liquid, is tightly regulated and can only be dispensed from designated methadone clinics in limited doses.

That means patients who take the drug during recovery must return regularly to methadone clinics. Valley Vista’s Bradford patients travel to St. Johnsbury — about half an hour away — and Vergennes patients must make the roughly 45-minute trip to Burlington to get methadone treatment, Hamel said.  

Valley Vista’s change in policy comes amid an apparent disagreement with state regulators over reimbursement for transportation to and from methadone clinics. 

In his email to Valley Vista staff Thursday, Hamel wrote, “We recognize that this is an underserved population; however, the reality is that the State of Vermont is unwilling to cover the transportation costs for patients to receive their doses.”

The situation appears to be more complex, however. 

Vermont Medicaid will pay for transportation to clinics, but only if the vehicles are “operated by a state contractor or subcontractor, in order to adhere to regulations regarding licensure and safety,” Alex McCracken, a spokesperson for the Department of Vermont Health Access, said in an email.

Under those rules, patients have access to various public transit operators across the state.

But Hamel, of Valley Vista, said riding on public transit could lead to safety concerns for the facility’s patients, and that schedules didn’t always line up. It’s safer and more effective for Valley Vista to have staff members drive patients and supervise their trips, he said. 

“It’s best to be in a closed environment with our staff bringing them, who are familiar with them, are aware of what’s going on with them,” Hamel said. “And can keep an eye on them to make sure that they’re not talking with other people at the clinic, to make sure that there’s nothing going on there.”

But Valley Vista is not eligible for Medicaid reimbursement if it drives patients on its own, which means the rehab center is footing the bill with no help from Medicaid. About 80% of Valley Vista’s patients are on Vermont Medicaid, according to Hamel.

From 2021 through mid-2023, the state Department of Health provided Valley Vista with Covid-19 funding for patients’ transportation to and from methadone clinics. 

But that money, which came from federal Covid-19 pandemic aid, “was always intended to be a short-term solution,” Kyle Casteel, a spokesperson for the Vermont Department of Health, said in an email.

Valley Vista could “use a transportation vendor whose expense is reimbursable through Medicaid or to obtain a new license for onsite methadone treatment from the (federal Drug Enforcement Administration),” Casteel said. “These options remain open to Valley Vista at this time and the Health Department is prepared to support Valley Vista should it choose to pursue either of these options.”

Since his email to staff Thursday morning, Hamel said Valley Vista and the state have set up a meeting next week to discuss the situation. 

Until then, however, the decision could create another barrier for Vermonters seeking treatment for substance use disorder.

“Vermonters continue to struggle with accessing the type of residential treatment that they need,” Christopher Smith, the chief clinical officer at the nonprofit Spectrum Youth and Family Services, said in an interview Thursday. 

“As a community, as a state, we need to put effort into building the residential treatment that’s going to work for all Vermonters,” Smith said. “And that means addressing appropriate funding and appropriate services that meet the needs of people who have addiction issues.”