STATE OF MINNESOTA IN COURT OF APPEALS A23
- 0210 In re the Estate of: Joanne Mary Ecklund, Decedent. Filed November 20, 2023 Affirmed Bjorkman , Judge Hennepin County District Court

File No. 27

- PA

- PR

- 21

- 1424 Mary F. Moriarty, Hennepin County Attorney, Matthew D. Hough, Assistant County Attorney, Minneapolis, Minnesota (for appellant Hennepin County Human Services) Keith Ellison, Attorney General, Emily B. Anderson, Assistant Attorney General, St. Paul, Minnesota (for intervenor Commissioner of Human Services) Susan A. King, Taylor D. Sztainer, Mary Frances Price, Megan J. Renslow, M oss & Barnett, P.A., Minneapolis, Minnesota (for respondent Jerry R. Ecklund) Considered and decided by Connolly , Presiding Judge; Bjorkman , Judge; and Klaphake , Judge

. ∗ SYLLABU S The unambiguous language of Minn. Stat. § 256B.15, subd. 2(a) (2022) , limits a claim to r ecover from the estate of a person who received medical assistance to amounts paid for the cost of long

- term
- care services actually provided to that person

.

∗ Retired judge of the Minnesota Court of Appeals, serving by appointment pursuant to Minn. Const. art. VI, § 10.2 OPINIO N BJORKMAN , Judge Appellant

- county challenges the district court’s partial denial of its claim to recover from the estate of a person who received medical assistance for long

- term
- care services. Appellant argues that the district court erred by interpreting Minn. Stat. § 256B.15, subd. 2(a), to limit recovery to amounts paid for services provided to decedent , asserting that the plain language of the statute permits recovery of the amount of “ capitation ” pa yments it made to decedent’s managed

- care organization (MCO) to cover the cost of decedent’s long

- term
- care services

. Intervenor

- commissioner supports the county’s appeal and argues that federal law requires recovery of capitation payments. We affirm. FA CTS Decedent Joanne Ecklund (decedent) was enrolled in Minnesota’s medical

assistance program and received benefits through her MCO , Medica. During decedent’s lifetime, the medical

- assistance program made capitation payments, which are similar to insurance premiums, to Medica. Following her death in August 2021, appellant Hennepin County Human Services (the county ) 1 asserted a claim against the estate under Minn. Stat. § 256B.15 (2022) , seeking to re cover $66,052.62 as the portion of capitation payments attributable to long

- term
- care services. The estate’s personal representative, respondent Jerry R. Ecklund (Ecklund), opposed the claim. Ecklund argued, in relevant part, that the

1 C ounty human

- services agencies administer medical assistance in their respective counties under the supervision of the Minnesota Department of Human Services. Minn. Stat. § 256B. 05, subd. 1 (2022).3 scope of a n estate
- recovery claim is limited under Minn. Stat. § 256B.15, subd. 2(a), and does not include capita tion payments. The county and Ecklund filed opposing motions for summary judgment based on stipulated facts. The district court concluded that the county is enti tled to recover but that the plain language of Minn. Stat. § 256B.15, subd. 2(a), does not permit recovery of capitation payments made to Medica ; it permits recovery of only the amount that Medica paid to providers for services actually provided to deceden t , which undisputedly is $8,806.84

. Accordingly, the court granted the county partial summary judgment for that amount, denying the remainder of the county’s claim. The county appealed and the Commissioner of Human Services ( commissioner ) intervened. 2 ISSUE Does Minn. Stat. § 256B.15, subd. 2(a), limit an estate

- recovery claim to amounts paid for long

- term
- care services actually provided to the decedent ? ANALYSIS Summary judgment is proper if the moving party shows that “there is no genuine issue as to any material fact and the movant is entitled to judgment as a matter of law.” Minn. R. Civ. P. 56.01. Where, as here, a district court grants summary judgment

“ based on the application of a statute to undisputed facts, the result is a legal conclusion, ”

2 The commissioner may “ intervene as a party in any proceeding involving recovery of medical assistance. ” Minn. Stat. § 256B.15, subd. 9.4 which we review de novo. In re Est

. of Handy , 672 N.W.2d 214, 217 (Minn. App. 2003), rev. denied (Minn. Feb. 17, 2004). When interpreting statutes, our role is to identify and effectuate the legislature’s intent. Minn. Stat. § 645.16 (2022); Pfoser v. Harpstead , 953 N.W.2d 507, 516 (Minn. 2021). We begin by examin ing the statute’s language to determine if it is ambiguous , meaning it “ is susceptible to more than one reasonable interpretation.” A.A.A. v. Minn

. Dep ’ t of Hum. Servs. , 832 N.W.2d 816, 819 (Minn. 2013)

. In determining whether a statute is ambiguous, we consider the whole statute, not just disputed language. Id

. And w e read the statute as it is, without adding language

. Firefighters Union Loc. 4725 v. City of Brainerd , 934 N.W.2d 101, 109 (Minn. 2019)

. We construe undefined words and phrases according to their common usage and may consider dictionary definitions. Minn. Stat. § 645.08(1) (2022); Pfoser , 953 N.W.2d at 517. But a term’s meaning also depends on its
context
. Getz v. Peace , 934 N.W.2d 347, 355 (Minn. 2019)

. If we discern the legislature’s intent from the statute’s plain language, we are constrained to apply that unambiguous meaning

. In re Schmalz , 945 N.W.2d 46, 50 (Minn. 2020)

. Minnesota provides “medical assistance” to people whose financial resource s are insufficient to meet the cost of necessary healthcare services. Minn. Stat. § 256B.01 (2022); see also Pfoser , 953 N.W.2d at 514 (explaining that medical assistance is Minnesota’s implementation of Medica id )

. Following the death of a medical

- assistance recipient, Minn. Stat. § 256B.15 provides for recove ry from the ir estate
. 3 Th is estate
3 The commissioner argues that federal Medicaid law mand ates recovery of capitation payments , citing the r equir ement that “[a] State plan for medical assistance ” provide for5 recovery statute begins by stating its un derlying policy

— that those who receive medical assistance “ use their own assets to pay their share of the cost of their care. ” Minn. Stat. § 256B.15, subd. 1(a). To effectuate this policy, the statute requires that, upon the death of a person who receive d medical assistance, “ the amount paid for medical assistance

. . . shall be filed as a claim against the estate of the person .” Id. , subd. 1a(a). Such claim s

“ shall be filed ” only if medical assistance was “ rendered for ” the person under certain circumstances , including if “ the person was 55 years of age or older and received medical assistance services that consisted of nursing facility services, home and community

- based services, or related hospital and prescription drug benefits. ” Id. , subd. 1a(e)(3). And the legislature specified that estate
- recovery claims “shall include only ” specified amounts, including “ the amount of medical assistance rendered to recipients 55 years of age or older that consisted of nursing facility services, hom e and community

- based services, and related hospital and prescription drug services.” Id. , subd. 2(a). It is the meaning of this claim

limitation provision that is at issue here. The parties contend this provision is unambiguous b ut offer competing interpretations. The county and the commissioner argue that the provision unambiguously means that an estate

- recovery claim includes the amount of capitation payments rendered

the state to seek recovery from certain recipients’ estates

. 42 U.S.C. § § 1396a(a)(18) , 1396p(b)(1)(B)(i) (2018)

. The Minnesota legislature plainly adopted Minn. Stat. § 256B.15 to comply with this requirement. See Minn. Stat. § 256B.22 (2022) (stating that medical

- assistance statutes “are intended to comply with” federal Medicaid law). But the commissioner acknowledges that this appeal turns on the interpretation of Minn. Stat. § 256B.15 and, therefore, parallel provisions in federal law are relevant here only if the state statute is ambiguous. See Schmalz , 945 N.W.2d at 50

.6 to an MCO on behalf of a medical

- assistance recipient to pay for the cost of the enumerated long

- term
- care services. They urge us to focus on the phrase “medical assistance , ” which is defined as “payment of part or all of the cost of the care and services identified [as covered services] in section 256B.0625, for eligible individuals whose income and resources are insufficient to meet all of this cost.” Minn. Stat. § 256B.02, subd. 8 (2022) ;

see Minn. Stat. § 256B.0625 (2022) ( listing covered services)

. They assert that this definition includes capitation payments , advancing similar but distinct justifications. The county emphasizes the “payment” part of the definition , arguing that, for people like decedent who receive medical assistance through an MCO, the state renders “ payment ” for covered s ervices by making capitation payments to the MCO

. The commissioner emphasizes the “cost” part of the definition, arguing that capitation payments are “the cost of [covered] services

. ” We reject the county and the commissioner’s interpretation for two

rea sons. First, the term “capitation” is conspicuously absent not only from the claim

limitation provision at issue but from the estate

- recovery statute as a whole

. See generally Minn. Stat. § 256B.15. By contrast, the legislature uses the term repeatedly in other medical

- assistance statutes. For example, it mandates that the commissioner develop “capitation rates” and details standards for doing so. Minn. Stat. § 256B.6928, subd. 3 (2022). It requires that “ capi tation rates ” or “capitation payments” be adjusted to account for various services being included or excluded from covered services . Minn. Stat. § 256B.0625, subds. 5m(d), 17a(b), 52(a). And i t defines the term “prepaid health plan” in terms of receipt o f “ a capitation payment
. ” Minn. Stat. § 256B.02, subd. 13 (2022)

. In7 short, the legislature knows how to include capitation payments in a statute but chose not to do so in the estate

- recovery statute. Under these circumstances, t he “black

- letter rule ” prohibiting us from adding language to a statute “has special force

. ” Firefighters Union , 934 N.W.2d at 109

. Second, the claim

- limitation provision’s use of the phrase “medical assistance” does not bridge this gap. As we noted above, “medical assistance” refers to payment of the cost of covered services. Minn. Stat. § 256B.02, subd. 8

. The term “capitat ion” refers to a similar sounding concept

— “a method of payment for health services that involves a monthly per person rate paid on a prospective basis to a health plan.” Minn. R. 9500.1451, subp. 4 (2021). But the concepts are distinct

. The state makes capitation payments to an MCO based on rates that anticipate the cost of covered services by considering recent years’ price and utilization data from the “medical assistance population

. ” Minn. Stat. § 256B.6928, subd. 3 (a)(1)

- (2), (b)

. T he rate also includes a “nonbenefit component” to cover the MCO ’ s operational expenses

. Id. , subd. 3(a) (3). I n exchange for capitation payments , the MCO take s on the “ financial risk ” of providing “ medical assistance services .” Minn. Stat. § 256B.02, subd. 13 ; see Getz , 934 N.W.2d at 356 (describing this “exchange”)

. The MCO manage s this risk by negotiat ing with healthcare providers to secure discounts for the cost of covered services that they prov ide to medical

- assistance recipients

. See Getz , 934 N.W.2d at 356 & n.9. As a result, d epending on the extent of covered services that a recipient actually receives a nd the extent of discounts that the MCO negotiat e s with providers , the amount the MCO receives in8 capitation for the recipient may be more or less than the amount it pays for covered services that the recipient actually receives. 4 In short, a capitation payment enable s and even requires an MCO to pay the cost of

covere d services, but it is not itself the cost of covered services or payment of that cost
. As such, it is not medical assistance for purpose s of recovery from a recipient’s estate

. Accordingly, the county and the commissioner’s interpretation of the limitation provision as allowing recovery of capitation payments is unreasonable. Ecklund advances a different interpretation of the claim

- limitation provision

— that
an estate
- recovery claim is limited to the amount paid for the cost of the enumerated long

term
- care services that were actually provided to the medical

- assistance recipient. He contends the phrase “rendered to recipients” requires this interpretation. We agree. The term “render” means to “give” or “provide.” The American Heritage Dictionary of the English Language 1487 (5th ed. 201 1 )

. T he phrase “rendered to recipients” modifies the phrase “medical assistance” because it immediately follows that phrase. In re Est. of Butler , 803 N.W.2d 393, 397 (Minn. 2011) ( stating that “ a qualifying phrase ordinarily modifies only the noun or phrase it immediately follows ”). The two phrases together refer to payment of the cost of covered services provided to recipients

. T his phrase, in turn, could mean that (1) the referenced payment was provided to recipients directly , (2) the referenced payment was provided to recipients indirectly, or (3) the

4 For example, in this case Medica received $66,052.62 in capitation payments for decedent’s long

- term
- care services but paid only $8,806.84 to providers for services that decedent received.9 referenced services were provided to recipients. Only one of these three interpretations is reasonable. P ayment of the cost of covered services provided to recipients cannot mean that the payment was provided directly to the person receiving the covered services because medical

- assistance p ayments are not made directly to the recipient ; they are made “to the vendor.” Minn. Stat. § 256B.03, subd. 1 (2022)

. Nor are we persuaded that the phrase refers to indirect payment on the recipient’s behalf because it would mean that medical assistance, which encompasses concepts of payment and services, is “rendered to” a recipient even if ne ither payment nor services were actually provided to the recipient. This means that the only reasonable interpretation of the phrase “medical assistance rendered to recipients” refers to the services part of “medical assistance,” meaning covered services that were provided to the recipient. Consideration of the rest of the estate
- recovery statute convinces us that this services

- oriented reading of Minn. Stat. § 256B.15, subd. 2(a), is the only reasonable one. See Getz , 934 N.W.2d at 355 ( requiring conside ration of statutory context in plain

- language analysis )

. First, the latter portion of that provision , referring to specific long

- term
- care services, makes more sense when “medical assistance” refers to services

. It is undisputed that actuarial analysis can define the portion of capitation payments attributable to anticipated use of particular services ; as a result, interpreting the provision to refer to “medical assistance [payments]

. . . that consisted of” the listed long

- term
- care services sounds odd but may make sense. But i nterpreting the provision to refer instead to services actually provided to a recipient

— specifically, “medical assistance [s ervices]

. . . that10 consisted of” the listed long

- term
- care services

— affords a more natural reading and a clearer and more concrete rubric

. See Krueger v. Zeman Const r . Co. , 781 N.W.2d 858, 861 (Minn. 2010) (stating that courts construe statutory language words and phrases

“ according to their most natural and obvious usage ” (quotation omitted)). Moreover, the estate

- recovery statute ’s claim

- filing requirement only applies “ if medical assistance was rendered for

. . . [a] person [who] was 55 years of age or older and received medical assistance services that consisted of [long

- term
- care services]

. ” Minn. Stat. § 256B.15, subd. 1a(e)(3) (emphasis added). This is consistent with the legislature’s articulated p olicy that the estate

- recovery statute does not call for maximiz ing recovery ; it calls for equitable contribution for services received by collecting from medical

- assistance recipients ’ estate “ their share of the cost of their care. ” Minn. Stat. § 256B.15, subd. 1(a) (emphasis added) ; s ee In re Est. of Turner , 391 N.W.2d 767, 770 (Minn. 1986) (stating that
estate
- recovery statute creates a “ system whereby money paid to qualified individuals for health care purposes may be recovered and reused to help other similarly situated persons ”). In sum, b ased on our careful consideration of the estate

- recovery statute as a whole ,
we conclude that the only reasonable interpretation of Minn. Stat. § 256B.15, subd. 2(a), is that a n estate
- recovery claim is limited to the amount paid for the cost of covered services that were actually provided to the person receiving medical assistance

. The clai m does not include c apitation payments. In light of this conclusion, we decline to address the parties’ arguments regarding extrinsic factors like agency guidance, parallel federal provisions,11 legislative history, and the consequences of this interpretati on. 5 See Schmalz , 945 N.W.2d
at 50 (stating that courts “ will not disregard a statute ’ s clear language to pursue the spirit of the law ” (quotation omitted))

. DECISIO N Because Minn. Stat. § 256B.15, subd. 2(a), limits an estate

- recovery claim to the amount paid for long

- term
- care services actually provided to a medical

- assistance recipient, the district court did not err by applying that unambiguous meaning and denying the porti on of the county’s claim that exceed s that amount. Affirmed.

5 All three parties advance arguments as to the consequences of the competing statutory interpretations. While we decl ine to substantively address those arguments, we note that the commissioner’s concern that our interpretation of Minn. Stat. § 256B.15 , subd. 2(a), places Minnesota out of compliance with federal law is , as she acknowledges, a matter between the state and the federal government, not the state and Ecklund. And if the legislature shares the commissioner’s concerns, it has the power to amend the statute accordingly. See State v. Khalil , 956 N.W.2d 627, 642 (Minn. 2021) (statin g that, if legislature intends something other than court’s plain

- language interpretation, it may reexamine and amend the statute) ; see also Getz , 934 N.W.2d at 357 ( stating if a statute “needs revision in order to make it embody a more sound public policy , the Legislature, not the judiciary, must be the reviser” (quotation omitted)).