In re Estate of Vollmann
296 Neb. 659
Neb.2017Background
- Herman M. Vollmann (age 78) died in 2014 after receiving services at two nursing facilities; DHHS paid $22,978.35 on his behalf and filed a claim against his estate.
- Cathy Densberger, personal representative, disallowed the DHHS claim and asserted only $360.45 was for medical treatment.
- DHHS sued for allowance of its claim under Nebraska’s Medical Assistance Act; parties filed cross-motions for summary judgment.
- County court granted summary judgment to DHHS; Densberger appealed.
- Central legal question: whether “medical assistance” (and thus recoverable sums) includes nursing-facility room, board, and other nonmedical facility costs.
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 services; room/board are nonmedical and not recoverable | Federal and state law define medical assistance to include nursing facility services, and nursing-facility services include routine room and dietary services | Court: Yes; medical assistance includes room/board and related facility costs, so recoverable |
| Whether § 68-919 authorizes DHHS to recover the total amount paid from a recipient’s estate | Statute distinguishes medical assistance from medical institution costs; does not authorize recovery of nonmedical expenses | § 68-919 makes recipient indebted for the total amount paid for medical assistance; defined to include nursing facility services | Court: § 68-919 covers the total amount of medical assistance paid, which includes nursing-facility room/board |
| Whether federal recovery statute (42 U.S.C. § 1396p) limits recovery to "traditional medical" items and/or prevents recovery of nonmedical facility costs | § 1396p contemplates recovery only for traditional medical items like nursing, hospital, prescriptions, not room/board | § 1396p explicitly authorizes recovery of nursing facility services; federal law requires states to seek recovery of medical assistance correctly paid | Court: § 1396p(b)(1) authorizes recovery of nursing-facility services; federal law supports state recovery |
| Whether summary judgment was improper because of factual dispute over whether costs were "medical assistance" | Affidavit claimed most expenses were nonmedical, creating a factual dispute | The question is one of law (statutory/regulatory interpretation), so no factual dispute prevents summary judgment | Court: Summary judgment proper; characterization is legal issue and DHHS entitled to judgment |
Key Cases Cited
- Edwards v. Hy-Vee, 294 Neb. 237 (discussing state obligations when participating in Medicaid)
- Maycock v. Hoody, 281 Neb. 767 (state compliance with Medicaid program requirements)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Nebraska Medicaid administration principles)
- Stewart v. Nebraska Dept. of Rev., 294 Neb. 1010 (statutory language given plain meaning)
- Cisneros v. Graham, 294 Neb. 83 (statutes in pari materia construed together)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (agency regulations have effect of law)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (distinguishes allocation of recovery between recipient and state)
- West Virginia v. U.S. Dept. Health & Human Servs., 289 F.3d 281 (federal/state allocation of recovered Medicaid funds)