In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Herman M. Vollmann (age 78) died in 2014; Nebraska DHHS filed an unsecured claim against his estate for $22,978.35 paid while he was a Medicaid recipient over age 55 for services at two nursing facilities.
- DHHS payments were made on a per‑diem basis under Nebraska’s Medicaid nursing facility rate methodology; per‑diem rates included components for room, dietary, nursing, and other allowable costs.
- Personal representative Cathy Densberger disallowed the claim; DHHS petitioned for allowance and both parties moved for summary judgment in county court.
- County court granted DHHS’s motion, ruling the challenged amounts (including room and board and other nonmedical facility expenses) constituted recoverable “medical assistance”; Densberger appealed.
- On appeal, the Nebraska Supreme Court reviewed statutory and regulatory definitions of “medical assistance,” “nursing facility services,” and state rate rules and affirmed summary judgment for DHHS.
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 limited to traditional medical treatment; nonmedical costs (room/board) are not recoverable | Federal and state definitions and regulations treat nursing facility services as medical assistance and include routine room/dietary costs | Court held such costs are part of medical assistance and recoverable from the estate |
| Whether § 68‑919 permits DHHS to claim the total amount paid for medical assistance | Statute distinguishes medical assistance from institutional nonmedical costs; does not authorize recovery of nonmedical expenses | § 68‑919 makes a recipient indebted for total amount paid as medical assistance; definitions include nursing facility costs | Court held § 68‑919 requires repayment of total medical assistance paid, which includes nursing facility room/board |
| Whether federal recovery statute § 1396p limits recovery to only clinical services | § 1396p’s reference to medical assistance should be read narrowly to clinical services (nursing/hospital/prescription) | § 1396p(b)(1) expressly authorizes recovery of nursing facility services, which are defined to include routine nonmedical components | Court held § 1396p authorizes recovery of nursing facility services, including room/board |
| Whether summary judgment was improper due to disputed facts about which charges were "medical" | Factual dispute exists whether specific charges were medical vs nonmedical, precluding summary judgment | The question is one of statutory/regulatory interpretation (law), so summary judgment was appropriate | Court held issue is legal, not factual, and affirmed summary judgment for DHHS |
Key Cases Cited
- Edwards v. Hy‑Vee, 294 Neb. 237, 883 N.W.2d 40 (Neb. 2016) (state must comply with Medicaid standards once it elects program participation)
- Maycock v. Hoody, 281 Neb. 767, 799 N.W.2d 322 (Neb. 2011) (statutory interpretation principles reiterated)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544, 811 N.W.2d 246 (Neb. 2012) (administration of Nebraska Medicaid program by DHHS)
- Stewart v. Nebraska Dept. of Revenue, 294 Neb. 1010, 885 N.W.2d 723 (Neb. 2016) (plain‑meaning rule for statutes)
- Cisneros v. Graham, 294 Neb. 83, 881 N.W.2d 878 (Neb. 2016) (statutes in pari materia should be construed together)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919, 863 N.W.2d 171 (Neb. 2015) (agency regulations have force of law)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (2006) (U.S. Supreme Court decision on apportionment of third‑party recoveries; distinguished on facts)
- West Virginia v. U.S. Dept. of Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (explains federal crediting of recovered estate funds between state and federal government)