In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Herman M. Vollmann (age 78) died leaving an estate; DHHS filed an unsecured claim for $22,978.35 representing Medicaid payments made to two nursing facilities while he was over 55.
- DHHS payments were calculated at facility-specific per diem rates set under Nebraska’s Medicaid plan, net of Vollmann’s share of cost.
- Personal representative Cathy Densberger disallowed the claim; DHHS petitioned for allowance and moved for summary judgment; county court granted DHHS’ motion.
- Densberger conceded DHHS must pay for nursing home services including room and board, but argued DHHS may not recover nonmedical costs (room/board/administration) from the estate.
- DHHS argued federal and state Medicaid statutes and regulations define “medical assistance” to include nursing facility services, which under the state payment methodology include room, dietary, and other routine costs.
- The sole legal dispute presented on appeal was whether DHHS may recover from the estate amounts paid for room and board and other nonmedical components of nursing facility services.
Issues
| Issue | Plaintiff's Argument (Densberger) | Defendant's Argument (DHHS) | Held |
|---|---|---|---|
| Whether DHHS may recover from the estate Medicaid payments for room and board and other nonmedical nursing-facility costs | §68-919 and federal law do not authorize recovery for "nonmedical" expenses; only traditional medical items should be recoverable | Federal statute defines “medical assistance” to include payment for nursing facility services; state statutes/regulations and payment methodology treat routine room/dietary/nursing services as part of nursing-facility services, so total amounts paid are recoverable | DHHS may recover the total amount paid for nursing-facility services (including room and board) from the estate |
| Whether recovery here is inequitable or amounts to unfair windfall (undue hardship / unconscionability) | Recovering ~71% of net estate is unconscionable and effectively takes the entire estate | Recovery is authorized by statute; waiver for undue hardship is discretionary and no statutory undue-hardship exceptions applied here | No undue-hardship grounds shown; DHHS permissibly pursued recovery and may decline to waive claim |
| Whether summary judgment was improper because facts disputed the medical nature of expenses | Affidavit asserted most expenses were nonmedical, creating a material fact issue | The characterization of what counts as "medical assistance" is a legal question governed by statutes/regulations, so no factual dispute defeats summary judgment | Summary judgment appropriate because the issue is one of law and statutory/regulatory definitions control |
Key Cases Cited
- Edwards v. Hy-Vee, 294 Neb. 237 (Neb. 2016) (state must comply with Medicaid program requirements if it elects to participate)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (Nebraska’s participation and administration of Medicaid)
- Ahlborn, 547 U.S. 268 (U.S. 2006) (allocation of third-party recovery between recipient and state Medicaid lien—distinguished)
- West Virginia v. U.S. Dept. Health and Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal/state sharing of recovered Medicaid funds)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (Neb. 2015) (agency regulations have force of law)