Nay v. Department of Human Services

385 P.3d 1001, 360 Or. 668, 2016 Ore. LEXIS 791
CourtOregon Supreme Court
DecidedDecember 15, 2016
DocketCA A150722; SC S062978
StatusPublished
Cited by16 cases

This text of 385 P.3d 1001 (Nay v. Department of Human Services) is published on Counsel Stack Legal Research, covering Oregon Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Nay v. Department of Human Services, 385 P.3d 1001, 360 Or. 668, 2016 Ore. LEXIS 791 (Or. 2016).

Opinion

BALDWIN, J.

The decision of the Court of Appeals is affirmed in part and vacated in part. The rule amendments to OAR 461-135-0832(10)(b)(B)(viii) (2010) and OAR 461-135-0835 (l)(e)(B)(iii) (2010) are held invalid.

*670 BALDWIN, J.

In general, the Department of Human Services is required by law to recover Medicaid payments from those assets in which the Medicaid recipient had an interest at the time of death. In 2008, the department amended its administrative rules regarding the scope of that recovery. The amended rules allow the department to recover the payments from assets that the recipient had transferred to a spouse up to five years before a person applies for Medicaid. Pursuant to ORS 183.400, petitioner Tim Nay sought judicial review of those rule amendments in the Court of Appeals. The Court of Appeals agreed with petitioner that the amendments were invalid, Nay v. Dept. of Human Services, 267 Or App 240, 340 P3d 720 (2014), and the department sought review. As we will explain, we conclude that the rule amendments are invalid under ORS 183.400(4)(b) because they exceed the department’s statutory authority. Accordingly, we affirm the Court of Appeals.

I. BACKGROUND

A. Medicaid

This case involves the recovery of payments by the state under Medicaid. Medicaid “is a cooperative endeavor in which the Federal Government provides financial assistance to participating States to aid them in furnishing health care to needy persons.” Harris v. McRae, 448 US 297, 308, 100 S Ct 2671, 65 L Ed 2d 784 (1980). The full scheme is quite complex, but most of those details are not relevant to our analysis here. (For a more detailed explanation of the legal framework, see Nay, 267 Or App at 242-45.) It is sufficient here to note that (1) a person may be eligible to receive certain benefits under the program, and (2) those benefits later may be recovered by the state from certain assets. The latter aspect — the recovery of those benefit payments by the state, known as “estate recovery” — is the issue on which this case turns.

B. Estate Recovery

1. Current Statutes

We first briefly address the relevant federal and state statutes regarding the recovery of those Medicaid *671 benefit payments. In doing so, we must consider which version of the federal and state statutes we should examine. The parties and the Court of Appeals all appear to have quoted the current versions of those statutes. Many of those statutes, however, have been amended multiple times since the rule amendments were first promulgated in 2008. 1

It is plausible that the validity of the rule amendments should be evaluated against the versions of the statutes in effect when the rules were amended, and not by later versions. The parties did not address that question in their briefing. However, we have reviewed the statutory amendments since 2008 and do not find any substantive changes that would affect our analysis of the issues here. Thus, we follow the lead of the parties and the Court of Appeals and quote all relevant statutes as they exist currently.

2. Federal Statutes

Federal law generally prohibits recovery of properly paid Medicaid benefits, except from the Medicaid recipient’s estate. The relevant statute provides, in part:

“(b) Adjustment or recovery of medical assistance correctly paid under a State plan
“(1) No adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan may be made, except that the State shall seek adjustment or recovery of any medical assistance correctly paid on behalf of an individual under the State plan in the case of the following individuals:
“(A) In the case of an individual described in subsection (a)(1)(B) of this section, the State shall seek adjustment or recovery from the individual’s estate * * *
“(B) In the case of an individual who was 55 years of age or older when the individual received such medical *672 assistance, the State shall seek adjustment or recovery from the individual’s estate, but only for [certain identified forms of medical assistance.]”

42 USC § 1396p(b)(l) (boldface in original).

Because recovery can be made only from the Medicaid recipient’s estate, much depends on what “estate” means. Federal law provides some guidance on that as well. The federal statute defining “estate,” 42 USC § 1396p(b)(4), contains two parts. The first part provides that the Medicaid recipient’s estate includes whatever state probate law defines as the estate. The statute also gives states the option to choose to expand that definition, so that it includes not only the probate estate, but also other property interests that the Medicaid recipient had at the time of death. Specifically, the statute provides, in part:

“(4) For purposes of this subsection, the term ‘estate,’ with respect to a deceased individual—
“(A) shall include all real and personal property and other assets included within the individual’s estate, as defined for purposes of State probate law; and
“(B) may include, at the option of the State * * *, any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survi-vorship, life estate, living trust, or other arrangement.”

42 USC § 1396p(b)(4).

The permissive definition of “estate” in subpara-graph (B) applies only to the extent of the interest that the Medicaid recipient held at the time of death. See 42 USC § 1396p(b)(4)(B) (permissive definition includes interest held at time of death, “to the extent of such interest”). The mere existence of a Medicaid recipient’s interest thus does not necessarily entitle a state to recover the full value of the asset. The state may recover only the value of the Medicaid recipient’s interest.

Estate recovery can occur only after the Medicaid recipient’s spouse also has died. 42 USC § 1396p(b)(2) (adding additional conditions).

*673 3. State Statutes

Oregon statutes generally parallel the federal provisions. ORS 416.350

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Cite This Page — Counsel Stack

Bluebook (online)
385 P.3d 1001, 360 Or. 668, 2016 Ore. LEXIS 791, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nay-v-department-of-human-services-or-2016.