Opinion ID: 2583977
Heading Depth: 2
Heading Rank: 2

Heading: Medicaid estate recovery

Text: The question before this court is one of statutory construction, namely, the meaning of federal and state Medicaid estate recovery statutes, 42 U.S.C. § 1396p(b)(2) and NRS 422.2935(2). [5] The phrase estate recovery statutes refers to a series of state and federal acts designed to recoup monies expended for Medicaid care from the estates of Medicaid recipients. The statutes limit recovery proceedings to protect surviving spouses or qualified dependents from poverty during their lifetimes or dependency. The propriety of the district court's order granting injunctive relief depends upon whether imposing a lien on a deceased Medicaid recipient's interest in a home before the surviving spouse's death is an impermissible recovery. Issues of statutory construction are subject to de novo review. [6] It is well established that [w]hen the language of a statute is plain and unambiguous, a court should give that language its ordinary meaning and not go beyond it. [7] However, if a statute is susceptible to more than one natural or honest interpretation, it is ambiguous, and the plain meaning rule has no application. [8] When a statute is ambiguous, the legislature's intent is the controlling factor in statutory interpretation. [9] Estate recovery acts encompass two important policy considerations relevant to the provision of medical care. First, the government has a legitimate statutory interest in recovering the amount of correctly paid Medicaid benefits from a deceased Medicaid recipient's estate, which includes the recipient's ownership interest in property at the time of death. [10] This interest arises from federal legislation mandating that states establish an estate recovery program in order to receive federal Medicaid funding. [11] Estate recovery provisions were initiated in light of increased demands for Medicaid, which stemmed from the growth of the nation's aging population. [12] Congress was concerned with projections indicating that Medicaid funding will be insufficient to meet claims within the next thirty years. [13] The federal statutes not only condition the states' receipt of Medicaid funding on efforts seeking recovery from a deceased recipient's probate estate, [14] but they also permit states to expand the definition of estate to include property held in joint tenancy and various other ownership interests at the time of death. [15] However, the federal and state statutes also reflect concern for the second policy consideration, avoiding spousal impoverishment. Congress has long been concerned with preventing spousal impoverishment. [16] The legislation attempts to strike a balance between these policies by limiting reimbursement efforts to situations where impoverishment is no longer an issue. [17] The foremost consideration is enabling states to help more people in need of Medicaid get assistance. [18] As a result of the federal legislation, Nevada created an estate recovery program. [19] Consistent with the federal mandate, the Nevada statutes broaden the definition of estate to include assets conveyed to a survivor, heir or assign of the deceased [Medicaid] recipient through joint tenancy, tenancy in common, survivorship, life estate, living trust or other arrangement. [20] Nevada's estate recovery statute furthers the government's legitimate interest in recovering, from a deceased Medicaid recipient's estate so that the government can help more people in need of assistance, the amount of benefits correctly paid. [21] To prevent impoverishment, the government is prohibited from executing its interest when the deceased recipient has a: (1) surviving spouse, (2) surviving child who is under 21 years old, or (3) surviving child who is blind or permanently and totally disabled. [22] In such circumstances, the government must delay executing its interest until the surviving spouse's death or the end of the dependency. This allows surviving spouses and qualified dependents to use assets, including any ownership interest in a home, to support themselves while recovery is deferred. Although the government is prohibited from executing its interest until the surviving spouse's death, the government's interest survives and continues with the property. Any individual who takes property upon the death of a Medicaid recipient, through inheritance, assignment, joint tenancy, etc., takes it subject to the government's interest. For instance, in this case, when Harold died and Agnes took Harold's interest in the home through joint tenancy, the government's interest survived. Similarly, any person who acquires an interest in the property through gift or fraudulent transfer, takes the property subject to the State's interest granted by the estate recovery statutes. [23] The federal Medicaid estate recovery statute, which is the basis for Nevada's statute, provides that any adjustment or recovery of medical assistance correctly paid to a deceased Medicaid recipient may be made only after the surviving spouse's death. [24] Nevada's Medicaid estate recovery statute provides that the government may not recover benefits until after the surviving spouse's death. [25] NSWD argues that imposing a lien before the surviving spouse's death is not an impermissible recovery. We agree. Turning to the plain language of the estate recovery statutes, the term recovery is not defined. In its every day use, the word recovery means the regaining of something lost or taken away. [26] A lien, in and of itself, does not permit the State to regain the sums it expended for Medicaid benefits. Rather, a lien is a security device that binds property to a debt and puts a party on notice that someone besides the owner of the property has an interest in that property. It is a claim, encumbrance, or charge on property for the payment of some debt, obligation or duty. [27] Repayment of the debt evidenced by the lien does not occur until the property is sold or foreclosed upon. [28] The Nevada statutes themselves support our conclusion that a lien is not a recovery. NRS 422.29355 permits liens to be placed against the real or personal property of a Medicaid recipient before or after the recipient's death. Moreover, after the recipient's death, a lien may be placed upon the undivided estate of the deceased recipient. [29] As noted above, the undivided estate is broadly defined and includes interests in real property that would normally be extinguished by death, such as joint tenancies. [30] Finally, a Nevada statute provides that the State may foreclose upon a lien, to the extent not prohibited by federal statute. [31] If a lien constituted a recovery, there would be no need for these statutory provisions. [32] Additionally, the federal and state statutes place restrictions on when a lien may be imposed during the lifetime of a Medicaid recipient, but contain no similar restrictions upon liens imposed after the death of the recipient. The failure of Congress and the Legislature to impose specific language on the imposition of post-death liens indicates that such liens are not prohibited. [33] While we are aware that the procedure for establishing a governmental interest in a deceased recipient's estate can be frightening and intimidating to the surviving spouse, there is nothing in the congressional record to indicate that imposing a post-death lien is an impermissible recovery. We conclude that a lien, in and of itself, is not an impermissible recovery. Agnes also contends that even if a lien is not a recovery, it becomes an impermissible recovery whenever the property subject to the lien is sold or encumbered by the surviving spouse. Agnes argues that the lien itself, if not subject to certain restrictions, has an undeniable chilling effect and becomes due and payable upon a legitimate transaction, such as refinancing the property, which defeats the purpose of ensuring against impoverishment. NSWD argues that the government's interest in the fiscal security of the Medicaid system is not adequately protected if it cannot impose liens. Specifically, NSWD argues that, when a surviving spouse transfers property for less than fair market value or as a gift, the government is frequently unable to execute its interest because the deceased recipient's remaining estate has insufficient assets and the property cannot be traced because the transferees have already conveyed the property to a good faith purchaser for value. Because the statutory language does not speak to the issue of a lien's effect upon sale or financing of the property, we construe it according to that which `reason and public policy would indicate the legislature intended.' [34] By delaying recovery until after the death of the surviving spouse, Congress has evidenced an interest in ensuring fiscal security for the surviving spouse and avoiding spousal impoverishment. By mandating that states establish estate recovery programs, Congress has established an interest in recovering benefits correctly paid from a deceased Medicaid recipient's estate. In balancing these two significant interests, Congress has created a system that defers recovery until the surviving spouse's death. It is clear that Congress intended that a surviving spouse be free to utilize the estate property during the spouse's lifetime. This would include the bona fide sale or financing of the property designed to provide the spouse with income from equity. A state's interest would be extinguished in such a transaction. A state's interest is not extinguished when the deceased recipient's interest in the property is transferred for less than fair market value. [35] Nevada's estate recovery statute is virtually identical to the federal statute. We assume, therefore, that the Legislature also intended to adopt a balance between recouping Medicaid benefits from a deceased recipient's estate and preventing spousal impoverishment. [36] We conclude that, to ensure adequate protection of the government's legitimate interest and help protect against fraudulent transfers, the government may impose a post-death lien during the surviving spouse's lifetime upon property in which it has a legitimate interest. However, we conclude that the government's right to impose a lien is not absolute. Nevada's lien statute requires that the lien accurately reflect the State's interest in the property. [37] The liens at issue in this case do not comply with the statute. First, the notice of lis pendens and the lien do not correctly identify the precise legal interest that the government is claiming, e.g., one-half interest of the property. Second, the notice of lis pendens, lien proceedings, and the lien itself fail to provide clear and unequivocal notice that the government will release the lien upon the surviving spouse's demand for any bona fide transaction, including, but not limited to, selling the property, refinancing the property, and obtaining a reverse mortgage. [38] In the instant case, the liens go beyond protecting NSWD's interest. Nothing in the notice of lis pendens and the proposed lien contains language indicating the surviving spouses are free to use or dispose of the property, through bona fide transactions, as a method of avoiding spousal impoverishment. Finally, the lis pendens and proposed lien do not accurately indicate they only apply to whatever interest the deceased Medicaid recipient had in the property before his or her death. We conclude that, without such language, the liens are overbroad and violate the spirit of federal and state laws designed to prevent spousal impoverishment. [39] Accordingly, we affirm the district court's entry of a permanent injunction prohibiting NSWD from pursuing the liens in their current form.