In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Herman M. Vollmann (78) received Medicaid-funded nursing facility care and died on Sept. 4, 2014; DHHS paid $22,978.35 to two nursing homes on his behalf.
- Cathy Densberger, personal representative of Vollmann’s estate, disallowed DHHS’ claim and asserted only $360.45 was for "medical expense."
- DHHS filed a petition for allowance of its claim; the parties filed cross-motions for summary judgment in county court.
- County court granted DHHS’ motion, ruling the payments (including room, board, and administrative charges) constituted recoverable "medical assistance." Densberger appealed.
- The question required statutory and regulatory interpretation of whether nursing facility per diem amounts (including room and board) are "medical assistance" recoverable from the recipient’s estate under state and federal law.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether "medical assistance" includes room and board and other nonmedical components of nursing facility per diem | Densberger: recovery limited to traditionally medical items; room/board are nonmedical and not recoverable | DHHS: federal/state definitions and regulations include nursing facility services and routine room/dietary services as medical assistance | Held for DHHS: nursing facility services include room/board and are recoverable as medical assistance |
| Whether § 68-919 allows DHHS to collect the total amount paid from an estate | Densberger: statute distinguishes medical assistance from costs of medical institutions; disallow broad recovery | DHHS: § 68-919 plainly makes recipient indebted for total amount paid for medical assistance | Held for DHHS: statute makes recipient indebted for total medical assistance paid |
| Whether federal recovery statute § 1396p limits recovery to "medical" (narrow) services | Densberger: § 1396p refers to traditional medical services (nursing, hospital, prescriptions) only | DHHS: § 1396p specifically authorizes recovery of nursing facility services, which encompass room/board | Held for DHHS: § 1396p authorizes recovery of nursing facility services (including room/board) |
| Whether summary judgment was improper due to disputed facts about character of expenses | Densberger: affidavit claims most expenses were nonmedical creating a fact issue | DHHS: whether sums qualify as "medical assistance" is a question of law, not factual dispute | Held for DHHS: legal question; summary judgment appropriate |
Key Cases Cited
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (discusses Nebraska's participation and obligations under Medicaid)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (Neb. 2015) (agency regulations have force of law)
- Stewart v. Nebraska Dept. of Revenue, 294 Neb. 1010 (Neb. 2016) (statutory language given plain and ordinary meaning)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (apportionment of recovery from third-party tort settlements between recipient and state)
- West Virginia v. U.S. Dept. of Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal crediting of recovered estate funds between state and federal government)