In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Herman M. Vollmann (age 78) died survived by five adult children; DHHS filed an unsecured claim against his estate for $22,978.35 representing Medicaid payments made while he was over 55 and residing in nursing facilities.
- DHHS paid facility-specific per diem amounts to two nursing homes based on Nebraska’s Medicaid rate-setting methodology; those per diems included room, dietary, nursing, and administrative costs.
- Personal representative Cathy Densberger disallowed the claim and argued only $360.45 constituted "medical expense," contending DHHS could not recover room-and-board or other nonmedical costs.
- DHHS filed for allowance of its claim; both parties moved for summary judgment. The county court entered summary judgment for DHHS, concluding nursing facility services (including room and board) are "medical assistance" recoverable from the estate.
- DHHS did not seek a waiver for undue hardship; statutory and regulatory schemes allow recovery from estates of recipients older than 55 unless limited by specific exceptions (e.g., surviving spouse, minor/disabled child, or undue hardship).
Issues
| Issue | Plaintiff's Argument (Densberger) | Defendant's Argument (DHHS) | Held |
|---|---|---|---|
| Whether "medical assistance" includes room and board and other nonmedical costs paid for nursing facility residents | Room, board, and administrative costs are nonmedical and not recoverable as "medical assistance" | Federal and Nebraska law define "medical assistance" to include nursing facility services; Nebraska regulations treat routine room/dietary services as part of nursing facility services and allowable costs | Court held room/board and related costs paid as part of nursing facility services are "medical assistance" and recoverable from the estate |
| Whether federal law restricts recovery only to clinically medical services (e.g., nursing, hospital, prescriptions) | Argues § 1396p and "medical assistance" refer only to traditional medical services, not room and board | § 1396p expressly authorizes recovery of nursing facility services; federal definitions and statutes include such services | Court rejected plaintiff’s narrow reading and held federal law authorizes recovery of nursing facility services (including room/board) |
| Whether recovery here would be inequitable/unconscionable because it consumes most of the estate | Asserts allowing recovery effectively deprives heirs and is unconscionable | Statutory scheme establishes eligibility, debt, and recovery; undue-hardship waivers exist but were not shown to apply | Court held no undue-hardship grounds were shown; recovery permitted under statute/regulation |
| Whether summary judgment was improper because material facts exist about whether expenses were "medical assistance" | Affidavit claims most expenses nonmedical, creating factual dispute | The question is one of law (statutory/regulatory interpretation), not factual; admitted payment records show per diem payments that include allowable costs | Court affirmed summary judgment because definition of "medical assistance" is a legal question and no genuine factual dispute prevented judgment |
Key Cases Cited
- Edwards v. Hy-Vee, 294 Neb. 237 (Neb. 2016) (Medicaid participation and compliance principles)
- Cisneros v. Graham, 294 Neb. 83 (Neb. 2016) (statutory construction in pari materia)
- Stewart v. Nebraska Dept. of Revenue, 294 Neb. 1010 (Neb. 2016) (plain-meaning rule for statutes)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544 (Neb. 2012) (Nebraska’s administration of Medicaid)
- Merie B. on behalf of Brayden O. v. State, 290 Neb. 919 (Neb. 2015) (agency regulations have force of law)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (addressed apportionment of third-party recoveries vis-à-vis Medicaid interests)
- West Virginia v. U.S. Dept. of Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal crediting of recovered estate funds under Medicaid)