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 nursing-home providers and submitted a $22,978.35 claim against his estate.
- Cathy Densberger, personal representative, disallowed the claim and argued nearly all payments were for room, board, and other nonmedical expenses (only $360.45 was "medical treatment").
- DHHS filed for allowance of its claim; the county court granted DHHS summary judgment.
- The central legal question was whether "medical assistance" (recoverable from a recipient’s estate) includes nursing facility room, board, and related nonmedical costs.
- Nebraska statutes and agency regulations set nursing-facility per diem rates based on allowable costs, which expressly include room and dietary services; federal Medicaid law defines "medical assistance" to include payment of nursing facility services.
- The estate had no surviving spouse or qualifying child and did not meet DHHS undue-hardship waiver criteria, so statutory recovery was permitted.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether "medical assistance" recoverable from an estate includes room, board, and other nonmedical nursing-facility expenses | Densberger: recovery limited to traditional medical treatment; room/board are nonmedical and not recoverable | DHHS: federal and state law treat nursing-facility services (including routine room/dietary costs) as "medical assistance" subject to recovery | Held: "Medical assistance" includes nursing-facility services; room, board, and related costs are recoverable from the estate |
| Whether federal Medicaid recovery statute §1396p limits recovery to "medical" as narrowly understood | Densberger: §1396p should be read to mean only traditional medical items (nursing, hospital, prescriptions) | DHHS: §1396p explicitly authorizes recovery of nursing facility services; federal definition covers facility services | Held: §1396p authorizes recovery of nursing facility services; state must seek recovery of such payments |
| Whether allowing DHHS recovery here is inequitable or amounts to taking the entire estate | Densberger: recovery (71% of net estate) is unconscionable; would deprive heirs of expected inheritance | DHHS: recovery arises from statutory eligibility, debt, and permissible waiver process; no undue-hardship fact presented | Held: No undue-hardship shown; statutory scheme permits recovery; inequity argument rejected |
| Whether summary judgment was improper because factual disputes exist about whether expenses were "medical assistance" | Densberger: affidavit asserts most expenses were nonmedical, creating a fact issue | DHHS: the question is one of law (statutory/regulatory interpretation), not factual dispute | Held: Question is legal; summary judgment appropriate for DHHS |
Key Cases Cited
- Arkansas Dept. of Health and Human Servs. v. Ahlborn, 547 U.S. 268 (2006) (discusses allocation of third-party recoveries between Medicaid recipient and state)
- West Virginia v. U.S. Dept. Health and Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal/state sharing when state recovers estate funds)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (2012) (Nebraska participation and administration of Medicaid program)
- Edwards v. Hy‑Vee, 294 Neb. 237 (2016) (state obligations under statutory schemes)
- Maycock v. Hoody, 281 Neb. 767 (2010) (interpretation of state administrative/benefit statutes)