State transportation official and emergency clinicians tell House Human Services committee encampments are straining services

Agency of Transportation staff, emergency clinicians and nonclinical emergency‑department workers told the House Human Services Committee that homeless encampments on state property and reductions in shelter capacity are shifting nonmedical needs into hospital emergency departments and imposing costs on multiple agencies.

Christopher Herrick, director of emergency management and safety for the Agency of Transportation, described a policy the agency developed for encampments on state rights of way (roadways, park‑and‑rides, rest areas, rail and aviation) and said his unit encountered and addressed 32 different encampments on state property in 2025. Herrick gave a preliminary accounting that his bureau spent about $126,000 on encampment responses in 2025, citing cleanup contractor costs (one job roughly $5,000) and hazardous‑materials removal billed at about $52,000; he said those are rough estimates and the full cost may be higher.

Kristen Bond Watts, a nurse in the emergency department at Porter Medical Center in Middlebury, said funding cuts to cold‑weather shelters have pushed unhoused individuals into ER waiting rooms as places to sleep. "Budget cuts to cold weather shelters are pushing unhoused individuals into our emergency department," she told the committee, adding that the center's 12‑bed ER is not designed to function as a shelter and that such use diverts Medicare and Medicaid resources and staff time away from true medical emergencies.

Julie Beath, an emergency medicine physician and medical director of the University of Vermont Medical Center emergency department, said federal EMTALA rules require emergency departments to provide a medical screening exam to anyone who presents for care, which limits hospitals' ability to refuse non‑medical shelter needs and contributes to repeated, costly visits. "EMTALA dictates that every patient that presents themselves to an emergency department is required by law to have what's called a medical screening exam," she said, and described examples including wound care and oxygen‑dependent patients who cannot safely store equipment when unhoused.

Amanda Meltzner, a nonclinical registration staff member at UVM Medical Center, said registration can flag patients who appear unhoused and that the hospital bills clinical hours to Medicare and Medicaid when people stay in the ED overnight for shelter. She said the department maintains a work queue for such encounters and uses address fields (e.g., COTS or Safe Harbor) as signals that a person is unhoused.

Herrick described outreach and coordination practices: AOT staff conduct on‑site assessments, coordinate with AHS and community partners like the Howard Center, provide safety items (he described bringing a carbon monoxide detector to one camper), and sometimes secure placements after repeated engagement. He said his team seeks consistency in how encampments are handled statewide and works to avoid forcing people onto other public property without services.

Committee members asked for the AOT encampment policy and more detailed cost and staffing breakdowns; Herrick agreed to share the policy and follow up figures. The committee scheduled additional hearings and witnesses on related topics later in the day.