In re Estate of Vollmann
296 Neb. 659
Neb.2017Background
- Herman M. Vollmann, a Medicaid recipient age 55+, died in 2014; DHHS filed an unsecured claim for $22,978.35 for services paid while he resided in two nursing facilities.
- DHHS payments were made on a per diem basis calculated under Nebraska’s Medicaid plan, reduced by Vollmann’s share of cost.
- Personal representative Cathy Densberger disallowed the claim and argued only $360.45 constituted “medical expense”; she moved for summary judgment while DHHS sought allowance of its claim.
- The county court granted DHHS summary judgment; Densberger appealed.
- Central legal question: whether Maryland/Nebraska law defines Medicaid “medical assistance” to include room, board, and other routine nonmedical costs of nursing facility care, permitting DHHS to recover those amounts from an estate.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does “medical assistance” include room, board, and other nonmedical nursing facility costs? | Densberger: recovery limited to traditional medical treatment; room/board are nonmedical and not recoverable. | DHHS: federal and Nebraska definitions treat nursing facility services as medical assistance and routine services include room, dietary, and related costs. | Yes. “Medical assistance” includes nursing facility services, which encompass room, board, and routine facility costs. |
| May DHHS recover the total amount paid on behalf of a recipient age 55+ from the recipient’s estate? | Densberger: allowing full recovery effectively takes the estate and is inequitable. | DHHS: §68‑919 creates a debt for the total amount of medical assistance paid; recovery is authorized unless a statutory exception or undue-hardship waiver applies. | Yes. §68‑919 makes the recipient indebted for the total amount paid; recovery permitted; no waiver or exception applied here. |
| Is DHHS’s claim treated as a lien or otherwise limited by federal lien provisions? | Densberger: federal lien/third-party recovery principles limit recovery to traditional medical expenses. | DHHS: claim was unsecured recovery under 42 U.S.C. §1396p(b)(1) for medical assistance (including nursing facility services). | The federal lien provision cited does not bar DHHS’s unsecured estate recovery; §1396p(b)(1) requires states to seek recovery of medical assistance including nursing facility services. |
| Was summary judgment improper because room/board classification is a factual question? | Densberger: affidavit asserted most expenses were nonmedical, creating a genuine issue of fact. | DHHS: classification of what constitutes “medical assistance” is a question of law resolved by statutes and regulations. | Summary judgment proper: the issue is one of law (statutory/regulatory interpretation), not a triable fact. |
Key Cases Cited
- Edwards v. Hy‑Vee, 294 Neb. 237 (Neb. 2016) (state Medicaid participation and compliance principles)
- Maycock v. Hoody, 281 Neb. 767 (Neb. 2010) (statutory interpretation principles)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (Nebraska Medicaid administration precedent)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (Neb. 2015) (agency regulations carry force of law)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (distinguishable; addressed allocation of third‑party recoveries)
- West Virginia v. U.S. Dept. of Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal/state share when estates are recovered)