In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Decedent Herman M. Vollmann (78) received Medicaid-funded nursing facility care and died on Sept. 4, 2014; DHHS paid $22,978.35 to two facilities while he was over 55.
- Personal representative Cathy Densberger disallowed DHHS’ claim and asserted only $360.45 was for "medical expense" while the balance constituted room/board and other nonmedical charges.
- DHHS filed a petition to allow its claim as an estate claim under Neb. Rev. Stat. § 68-919 and sought recovery of amounts it paid as "medical assistance."
- The county court granted DHHS’ motion for summary judgment, ruling that Medicaid "medical assistance" includes nursing facility charges such as room, dietary, and other routine facility costs and thus is recoverable from the estate.
- Densberger appealed, arguing (1) recovery for nonmedical expenses (room/board) is not authorized, (2) the State should not receive the estate’s value, and (3) summary judgment was improper due to factual disputes.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether "medical assistance" recoverable from an estate includes room, board, and other nonmedical nursing facility charges | Densberger: recovery limited to traditional medical treatment; room/board are nonmedical and not recoverable | DHHS: federal and state statutes/regulations define Medicaid "medical assistance" to include nursing facility services, and nursing facility services include routine room/dietary costs | Court: "medical assistance" includes nursing facility services; routine room/board costs are recoverable under § 68-919 and federal law |
| Whether federal Medicaid recovery statute (42 U.S.C. § 1396p) limits recovery to strictly clinical services | Densberger: § 1396p refers to medical services (nursing, hospital, prescription) and not nonmedical facility charges | DHHS: § 1396p expressly authorizes recovery of nursing facility services; nursing facility services encompass room and routine services as defined by statute/regulation | Court: § 1396p authorizes recovery of amounts for nursing facility services, which include room/board |
| Whether allowing DHHS’ claim unjustly strips the estate or is unconscionable | Densberger: enforcement would effectively transfer entire estate value to State; inequitable | DHHS: recovery is statutory/contractual consequence of receiving benefits; waivers for undue hardship exist but were not triggered | Court: statutory scheme governs recovery; no undue‑hardship waiver facts; collection lawful and not unconscionable |
| Whether summary judgment was improper due to factual dispute over whether charges were "medical assistance" | Densberger: affidavit asserts most charges were nonmedical, creating material fact issue | DHHS: issue is legal (statutory/regulatory interpretation), so summary judgment appropriate | Court: question is one of law; no material factual dispute preventing summary judgment |
Key Cases Cited
- Edwards v. Hy‑Vee, 294 Neb. 237 (Neb. 2016) (states must follow Medicaid statutory/regulatory requirements once they opt in)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (Nebraska’s participation and DHHS administration of Medicaid)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (distinguishes apportionment of third‑party recovery; not on point for estate recovery scope)
- West Virginia v. U.S. Dept. Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (describes federal/state sharing of recovered Medicaid funds)