In re Estate of Vollmann
296 Neb. 659
| Neb. | 2017Background
- Herman M. Vollmann (age 78) received Medicaid-covered nursing facility care and died on Sept. 4, 2014; DHHS paid $22,978.35 for services while he was over 55.
- Cathy Densberger, personal representative, disallowed DHHS’ unsecured claim and contested recovery from the estate.
- DHHS filed for allowance of its claim under Neb. Rev. Stat. § 68-919, asserting the estate is indebted for "the total amount paid for medical assistance" provided to recipients 55+ years old.
- The disputed amounts were per diem payments calculated under Nebraska’s Medicaid nursing-facility rate methodology (which includes room, dietary, and other routine facility costs).
- The county court granted summary judgment for DHHS; Densberger appealed arguing (1) room and board are nonmedical and not recoverable, (2) recovery unjustly consumes the estate, and (3) disputed factual issues precluded summary judgment.
Issues
| Issue | Plaintiff's Argument (Densberger) | Defendant's Argument (DHHS) | Held |
|---|---|---|---|
| Whether "medical assistance" recoverable from estate includes room, board, and other nonmedical nursing-facility costs | Recovery limited to traditional medical treatment (nursing, hospital, prescriptions); room & board are nonmedical and not recoverable | Federal and state definitions of "medical assistance" and "nursing facility services" include routine room, dietary, and related facility costs, so DHHS may recover those sums | Held for DHHS: nursing-facility services (including room & board) are "medical assistance" recoverable from estate under § 68-919 and 42 U.S.C. § 1396p(b)(1) |
| Whether federal recovery statutes (liens/estate recovery) restrict DHHS from claiming nonmedical facility costs | Federal recovery should be limited to "traditional medically related services"; lien provisions show narrower scope | 42 U.S.C. § 1396p(b)(1) mandates recovery of any medical assistance correctly paid, and expressly authorizes recovery for nursing facility services | Held for DHHS: federal law authorizes recovery of nursing-facility services as "medical assistance" |
| Whether collection would be inequitable / amount unconscionable (undue hardship) | Collecting ~71% of net estate is unconscionable and effectively confiscatory | Waiver/undue-hardship exceptions exist but were not shown; statutory scheme creates a debt and permits recovery except in limited circumstances | Held for DHHS: no undue-hardship showing; statutory recovery proper and not unlawfully profiteering |
| Whether summary judgment inappropriate due to disputed facts about whether expenses were "medical" | Affidavit claims most expenses were nonmedical, creating material factual dispute | Characterization is a question of law based on statutes/regulations; legal interpretation appropriate for summary judgment | Held for DHHS: issue is legal, not factual; summary judgment proper |
Key Cases Cited
- Edwards v. Hy-Vee, 294 Neb. 237, 883 N.W.2d 40 (Neb. 2016) (state participation in Medicaid subjects it to federal program requirements)
- Smalley v. Nebraska Dept. of Health & Human Servs., 283 Neb. 544, 811 N.W.2d 246 (Neb. 2012) (Nebraska administers Medicaid under state Medical Assistance Act)
- Cisneros v. Graham, 294 Neb. 83, 881 N.W.2d 878 (Neb. 2016) (statutes in pari materia construed together)
- Arkansas Dept. of Health & Human Servs. v. Ahlborn, 547 U.S. 268 (U.S. 2006) (discussed by appellant but factually distinguishable; involved apportionment of recovery against a living recipient’s tort award)
- West Virginia v. U.S. Dept. of Health & Human Servs., 289 F.3d 281 (4th Cir. 2002) (federal share credited when state recovers estate funds)