In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Herman M. Vollmann, a Medicaid recipient, died in 2014 at age 78; DHHS claimed $22,978.35 paid for his nursing-facility care while he was over 55; the personal representative, Cathy Densberger, disallowed the claim.
- DHHS’s payments to two nursing facilities were calculated as facility-specific per diem rates under Nebraska’s Medicaid plan, after Vollmann’s share-of-cost deductions.
- Densberger conceded the State must pay nursing-home services for Medicaid recipients but argued DHHS may not recover nonmedical portions (room, board, administrative charges) from the estate.
- DHHS sued for allowance of its claim; the county court granted DHHS summary judgment; Densberger appealed.
- The legal question turned on whether federal and state Medicaid statutes and implementing regulations define “medical assistance” to include nursing-facility costs such as room and board, thereby permitting estate recovery under Neb. Rev. Stat. § 68-919 and 42 U.S.C. § 1396p(b)(1).
Issues
| Issue | Plaintiff's Argument (Densberger) | Defendant's Argument (DHHS) | Held |
|---|---|---|---|
| Whether “medical assistance” includes room & board and other nonmedical nursing-facility costs | Recovery limited to traditional medical treatment; room/board are nonmedical and not recoverable | Federal/state definitions include nursing-facility services; routine facility costs (room, dietary) are part of nursing-facility services and thus medical assistance | Yes. Medical assistance includes nursing-facility costs such as room and board, so DHHS may recover them |
| Whether § 1396p(b)(1) and related federal law authorize recovery of such amounts | § 1396p intended only for traditional medical services, not nonmedical facility costs | § 1396p(b)(1) expressly requires recovery of any medical assistance paid, including nursing-facility services | § 1396p(b)(1) authorizes recovery of nursing-facility medical assistance |
| Whether recovery here is inequitable or constitutes an unlawful forfeiture of beneficiaries’ inheritance | Collecting most of the estate is unconscionable; undue hardship should bar recovery | Recovery is statutory contract-based; DHHS may waive for undue hardship but did not and regs narrowly define undue hardship | No undue hardship shown; statutory recovery permitted and not inequitable as matter of law |
| Whether summary judgment was improper because of factual dispute about what expenses were "medical" | Affidavit claiming most expenses were nonmedical creates material factual issue | Definition of “medical assistance” is a question of law; no factual dispute prevents judgment | Summary judgment proper; the issue is legal and DHHS entitled to judgment as a matter of law |
Key Cases Cited
- Edwards v. Hy-Vee, 294 Neb. 237 (Neb. 2016) (state compliance obligations when participating in Medicaid program)
- Maycock v. Hoody, 281 Neb. 767 (Neb. 2011) (statutory construction principles in state administrative context)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (DHHS administrative authority under the Medical Assistance Act)
- Stewart v. Nebraska Dept. of Rev., 294 Neb. 1010 (Neb. 2016) (plain-meaning rule for statutory language)
- Cisneros v. Graham, 294 Neb. 83 (Neb. 2016) (in pari materia treatment of related statutes)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (Neb. 2015) (agency regulations having effect of law)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (discussed reallocation of recovery proceeds; not controlling on Medicaid definition issue)
- West Virginia v. U.S. Dept. Health & Human Serv., 289 F.3d 281 (4th Cir. 2002) (federal crediting of recovered estate funds between state and federal shares)