In re Estate of Vollmann
296 Neb. 659
Neb.2017Background
- Herman M. Vollmann, a Medicaid recipient who died at 78, received nursing facility care; DHHS paid $22,978.35 for services provided while he was over 55.
- Cathy Densberger, personal representative of the estate, disallowed DHHS’s claim and asserted only $360.45 was for medical treatment.
- DHHS filed for allowance of its claim; both parties moved for summary judgment in county court.
- County court granted summary judgment for DHHS, treating the full amounts paid (calculated via Nebraska’s per diem nursing rates less recipient contribution) as recoverable medical assistance.
- Densberger appealed, arguing (1) recovery cannot include room-and-board/nonmedical expenses, (2) recovery would improperly exhaust the estate, and (3) factual issues precluded summary judgment.
Issues
| Issue | Plaintiff's Argument (Densberger) | Defendant's Argument (DHHS) | Held |
|---|---|---|---|
| Whether “medical assistance” recoverable from estate includes room and board and other nonmedical nursing-facility costs | §68-919 does not authorize recovery for nonmedical expenses; only traditional medical treatment is recoverable | Federal and state definitions and regulations treat nursing-facility services as "medical assistance," and routine facility costs (room, dietary, etc.) are included in allowable costs | Medical assistance includes nursing-facility services; room and board are recoverable |
| Whether federal Medicaid recovery statute (§1396p) limits recovery to narrowly ‘medical’ items like nursing and prescriptions | §1396p contemplates only traditional medical items, not routine facility costs | §1396p expressly authorizes recovery of nursing-facility services, which federal law defines to include services necessarily provided in an inpatient nursing facility | §1396p authorizes recovery of nursing-facility services (including room and board) |
| Whether allowing recovery would be inequitable or amount to improper confiscation of estate | Collecting roughly 71% of the estate is unconscionable and effectively strips heirs of inheritance | Recovery is authorized by the Medical Assistance Act; DHHS may waive for undue hardship but did not find grounds here | No inequity for purposes of statutory recovery; no undue-hardship waiver warranted on the record |
| Whether summary judgment was improper because genuine factual disputes exist about what expenses were ‘‘medical’’ | Affidavit asserts most expenses were nonmedical, creating a factual dispute | Characterization of the legal category “medical assistance” is a question of law, not a material factual dispute | Summary judgment appropriate because issue is legal interpretation of statutes/regulations |
Key Cases Cited
- Edwards v. Hy-Vee, 294 Neb. 237 (Neb. 2016) (state must comply with Medicaid program requirements when it elects participation)
- Maycock v. Hoody, 281 Neb. 767 (Neb. 2010) (interpretive principles for state Medicaid obligations)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (Nebraska’s Medicaid administration and state plan obligations)
- 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 construction of related statutes)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (Neb. 2015) (agency regulations have effect of statute when properly adopted)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (addressed apportionment of third-party recoveries between recipient and state)
- West Virginia v. U.S. Dept. Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal crediting of recovered estate funds between state and federal government)