PUBLISHED OPINION
Case No.: 95-0982-FT
†Petition for
Review Filed
Complete Title
of Case:
IN THE MATTER OF THE ESTATE OF
PAUL BUDNEY, DECEASED:
STATE OF WISCONSIN, DEPARTMENT
OF HEALTH AND SOCIAL SERVICES,
Appellant,†
v.
ESTATE OF PAUL BUDNEY,
Respondent.
Submitted on Briefs: July 5, 1995
Oral Argument: ----
COURT COURT
OF APPEALS OF WISCONSIN
Opinion Released: October 31, 1995
Opinion Filed: October 31, 1995
Source of APPEAL Appeal
from a judgment
Full Name JUDGE COURT: Circuit
Lower Court. COUNTY: Milwaukee
(If "Special", RESERVE JUDGE: WILLIS J. ZICK
so indicate)
JUDGES: WEDEMEYER,
P.J., SULLIVAN and FINE, JJ.
Concurred:
Dissented:
Appellant
ATTORNEYSFor
the appellant the cause was submitted on the briefs of James E. Doyle,
attorney general by Donald P. Johns, assistant attorney general.
Respondent
ATTORNEYSFor
the respondent the cause was submitted on the briefs of Angela E. Canellos
of Wauwatosa.
|
COURT OF APPEALS DECISION DATED AND RELEASED OCTOBER 31, 1995 |
NOTICE |
|
A party may file with the
Supreme Court a petition to review an adverse decision by the Court of
Appeals. See § 808.10 and Rule 809.62, Stats. |
This opinion is subject to
further editing. If published, the
official version will appear in the bound volume of the Official Reports. |
No. 95-0982-FT
STATE
OF WISCONSIN IN COURT OF
APPEALS
IN THE MATTER OF THE
ESTATE OF
PAUL BUDNEY, DECEASED:
STATE OF WISCONSIN,
DEPARTMENT
OF HEALTH AND SOCIAL
SERVICES,
Appellant,
v.
ESTATE OF PAUL BUDNEY,
Respondent.
APPEAL from a judgment
of the circuit court for Milwaukee County:
WILLIS J. ZICK, Reserve Judge. Affirmed.
Before Wedemeyer, P.J.,
Sullivan and Fine, JJ.
WEDEMEYER,
P.J. The Department of Health and Social Services appeals from
the trial court's judgment.[1] The trial court ruled that the department
could not recover from Paul Budney's estate medical assistance benefits paid on
behalf of Grace Budney, his predeceased wife, because federal law does not
authorize the recovery of benefits. The
issue is whether § 49.496(3)(a), Stats.,
which allows the department to recover medical assistance benefits paid on
behalf of a person from the estate of that person's surviving spouse, violates
federal law. We conclude that it
does. Accordingly, we affirm the trial
court's summary judgment in favor of the estate.
Grace Budney was a
resident of a nursing home and a recipient of medical assistance. She died after residing in the home for over
a year. A year after her death, her
husband Paul Budney died. After Paul
Budney's death, the department filed a claim against his estate for $54,042
pursuant to § 49.496(3)(a), Stats.,
seeking to recover medical assistance benefits paid on behalf of Grace Budney. The estate objected to the claim on the
ground that federal law prohibits the recovery of medical assistance benefits
paid on behalf of a predeceased spouse.
The trial court concluded that the Wisconsin statute violated 42 U.S.C.
§ 1396p(b) (1995) and granted summary judgment in favor of the
estate. The department appeals.
The State of Wisconsin
has enacted legislation which allows the Department of Health and Social
Services to file a claim against the estate of a recipient or against the
estate of the surviving spouse of a recipient for the amount of medical
assistance paid on behalf of the recipient while the recipient resided in a
nursing home. Section 49.496(3)(a), Stats.[2] Federal law mandates that State plans for
medical assistance comply with the provisions of 42 U.S.C. § 1396p with
respect to recovering medical assistance correctly paid. See 42 U.S.C.
§ 1396(a)(18). 42 U.S.C. 1396p(b)
provides:
(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:
....
(B) In the case of an individual who was 55
years of age or older when the individual received such medical assistance, the
State shall seek adjustment or recovery from the individual's estate ....
(2) Any
adjustment or recovery under paragraph (1) may be made only after the death of
the individual's surviving spouse, if any ....
In the first section,
the statute plainly prohibits a State from recovering medical assistance
benefits except in certain situations.
The statute provides that "[no] adjustment or recovery of any
medical assistance correctly paid on behalf of an individual under the State
plan may be made ... except in the case of the following individuals...." After this initial prohibition, the statute
does not specifically authorize a State to recover medical assistance benefits
from a recipient's surviving spouse's estate.
Because the statute does not counter the initial blanket prohibition by
specifically authorizing a State to recover medical assistance benefits paid on
behalf of a recipient from a surviving spouse's estate, we conclude that
§ 49.496(3)(a), Stats.,
which allows such recovery, exceeds the authority provided by the federal
statute. Accord Estate of
Craig, 624 N.E.2d 1003 (N.Y. 1993) (Federal law does not expressly
provide for recovery of Medicaid payments on behalf of a predeceased spouse
from the secondarily dying spouse's estate).
The trial court properly rejected the department's claim to recover from
Paul Budney's estate medical assistance paid on behalf of Grace Budney.
By the Court.—Judgment
affirmed.
[2]
Section 49.496(3), Stats.,
provides:
Recovery from Estates. (a) Except as provided in par.
(b), the department shall file a claim against the estate of a recipient or
against the estate of the surviving spouse of a recipient for all of the
following unless already recovered by the department under this section:
1. The amount of medical assistance paid on behalf of the recipient while the recipient resided in a nursing home or while the recipient was an inpatient in a medical institution and was required to contribute to the cost of care.