In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Herman M. Vollmann, a Medicaid recipient age 55+, died in 2014; Nebraska DHHS claimed $22,978.35 paid to two nursing facilities on his behalf.
- Personal representative Cathy Densberger disallowed the claim; DHHS filed a petition to allow recovery from the estate.
- DHHS payments were calculated as facility-specific per diem rates under Nebraska’s Medicaid plan, net of Vollmann’s share of cost.
- Densberger conceded the State must pay nursing home services for recipients but argued DHHS may not recover nonmedical costs (e.g., room and board).
- The county court granted DHHS summary judgment; Densberger appealed to the Nebraska Supreme Court.
Issues
| Issue | Plaintiff's Argument (Densberger) | Defendant's Argument (DHHS) | Held |
|---|---|---|---|
| Whether "medical assistance" includes room-and-board and other nonmedical nursing facility costs | Recovery is limited to traditional medical services; room and board are nonmedical and not recoverable | Federal and state law define Medicaid "medical assistance" to include nursing facility services, which by regulation include routine room, dietary, and related costs | Medical assistance includes nursing facility services; DHHS may recover room, board, and related costs paid on recipient’s behalf |
| Whether § 68‑919 permits DHHS to claim the total amount paid for medical assistance from a deceased recipient’s estate | Statute should not be read to allow recovery of nonmedical institutional costs | § 68‑919(1) makes recipients 55+ indebted for the total amount of medical assistance paid; nursing facility payments are ‘‘medical assistance’’ | § 68‑919 authorizes recovery of the total medical assistance paid, which includes nursing facility per diem components |
| Whether federal recovery statute § 1396p limits recoverable items to clinical services only | § 1396p should be read to cover only traditional clinical services (nursing, hospital, prescriptions) | § 1396p(b)(1) requires recovery of any medical assistance correctly paid, and expressly authorizes recovery for nursing facility services | § 1396p requires states to seek recovery of medical assistance, including nursing facility services |
| Whether summary judgment was improper because factual disputes exist about whether payments were "medical assistance" | Affidavit claiming most expenses were nonmedical creates a material fact issue | The question is one of statutory/regulatory interpretation (law), not fact | Summary judgment proper; interpretive legal question resolved for DHHS |
Key Cases Cited
- Edwards v. Hy‑Vee, 294 Neb. 237 (Neb. 2016) (states participating in Medicaid must comply with federal requirements)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (Nebraska’s administration of Medicaid and statutory construction principles)
- Cisneros v. Graham, 294 Neb. 83 (Neb. 2016) (in pari materia construction of statutes)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (Neb. 2015) (administrative regulations have force of law)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (addressed apportionment between recipient and state when recovering third‑party damages)
- West Virginia v. U.S. Dept. Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal/state payment and crediting of recovered Medicaid funds)