The Minnesota Appellate Court prevents the county from recovering capitation payments from the estate of a medical-assistance program participant. In Estate of Ecklund (Minn. Ct. App. A23-0210, November 20, 2023).
Joanne Ecklund was enrolled in Minnesota’s medical assistance program. Estimating the future costs of covered services, the state made capitation payments to her managed care organization. The organization then directly paid her covered costs.
After she died, the county sought to recover $66,052.62 in capitation payments for long-term care services, in addition to amounts paid directly to providers. The estate’s personal representative, Jerry R. Ecklund, argued that Minn. Stat. § 256B.15, subd. 2(a) does not allow recovery of capitation payments.
Agreeing with the estate representative, the court found that the statute’s plain language bars recovery of capitation payments. It determined that the statute only permits recovery of the amount paid to providers for services that Ms. Ecklund received. The court granted partial summary judgment to allow the county to recover the amount spent on provider payments but not capitation payments.
On appeal, the appellate court considers whether Minn. Stat. § 256B.15, subd. 2(a) limits an estate recovery claim to the cost of long-term care services the decedent actually received. The statute allows recovery for the “medical assistance rendered to recipients.”
The county and intervening Commissioner of Human Services argued that the statute includes capitation payments in recovery claims because of the definition of medical assistance. The statute defines it as payment of part or all of the cost of the covered care and services. They asserted that the cost of covered care and services encompasses capitation payments.
The appellate court rejects this argument. The estate recovery statute language does not include a reference to capitation payments. If the legislature had intended to allow recovery for capitation payments, it would have listed them in the statute.
Capitation is distinct from medical assistance. The state makes payments to managed care organizations based on estimates of care costs. The capitation for a recipient could be more or less than the amount the organization ultimately pays. Since capitation payments are not precise reflections of costs incurred, they are not medical assistance.
Mr. Ecklund’s argument persuades the appellate court. The only reasonable interpretation of the phrase “medical assistance rendered to recipients” is covered services actually provided to the recipient. The legislature intended for equitable, not maximum, recovery.
The district court’s decision was correct. The estate recovery statute limits recuperation to the costs of long-term care services the decedent actually received.
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