Estate of West v. Moffatt

• Decision Date: 28 November 2000
• Docket Number: Case Number: WD57683
• Citation: Estate of West v. Moffatt, 32 S.W.3d 648 (Mo. App. 2000)
• Parties: In the Estate of Donald D. West, Missouri Department of Social Services, Division of Medical Services, Appellant, v. Janice West Moffatt, Personal Representative, Respondent.
• Court: Missouri Court of Appeals

32 S.W.3d 648

In the Estate of Donald D. West, Missouri Department of Social Services,Division of Medical Services, Appellant, v. Janice West Moffatt, Personal Representative, Respondent.

Case Number: WD57683

Court of Appeals of Missouri, Western District

November 28, 2000

Appeal From: Circuit Court of Morgan County, Hon. Patricia F. Scott

Counsel for Appellant: Jennifer L. Barth

Counsel for Respondent: Kenneth M. Hayden

Opinion Summary:

The Department of Social Services appeals judgment in favor of the Estate of Donald D. West on the Department's claim seeking reimbursement under section 473.398, RSMoCum. Supp 1995, for Medicaid expenditures paid to Donald D. West, decedent.The court ruled in favor of the Estate because it determined that the Department failed to satisfy its burden of proving the expenditure of Medicaid benefits on Mr. West's behalf.The court sustained the Estate's objection to the Department's Exhibit 1, claim documentation, thereby precluding its consideration as evidence.The Department asserts, contrary to the trial court's rulings, that the confidentiality provisions of sections 208.120.1and208.155, RSMo 1994, do not bar admission of the Department's Exhibit 1, claim documentation, and that a proper foundation was laid to admit the exhibit.

REVERSED AND REMANDED.

Division Three holds:

(1) Where the issue in a section 473.398 proceeding seeking reimbursement of Medicaid benefits paid to a decedent is the amount received by the recipient, records of benefits received by a decedent are exempt from the confidentiality and inadmissibility provisions of sections 208.120.1and208.155.The court, therefore, erred in excluding Department's Exhibit 1.

(2) Where a Department estate recovery analyst testified as to the mode of preparation of the documents and that they made in the regular course of business reasonably near the time of payment, the Department laid a proper foundation for the admission of the claim documentation, Exhibit 1.The court, therefore, erred in excluding the exhibit and in granting the Estate's motion for directed verdict.

Opinion Author: Robert G. Ulrich, J.

Opinion Vote: REVERSED AND REMANDED.Smith, P.J., Ellis, J., concur.

Opinion:

The Department of Social Services of the State of Missouri(Department) appeals from the judgment of the probate court in favor of the Estate of Donald D. West(Estate) on the Department's claim seeking reimbursement under section 473.398, RSMoCum. Supp 1995, for Medicaid expenditures paid to Donald D. West, decedent.The court ruled in favor of the Estate because it determined that the Department failed to satisfy its burden of proving the expenditure of Medicaid benefits on Mr. West's behalf.The court sustained the Estate's objection to the Department's Exhibit 1, claim documentation, thereby precluding its consideration as evidence.The Department asserts, contrary to the trial court's rulings, that the confidentiality provisions of sections 208.120.1and208.155¹ do not bar admission of the Department's Exhibit 1, claim documentation, and that a proper foundation was laid to admit the exhibit.The issues presented, therefore, are whether either section 208.120.1 or 208.155 precludes introduction as evidence decedent West's records of his receipt of Medicaid benefits in a section 473.398 proceeding where the state is seeking reimbursement from Mr. West's estate for Medicaid payments made in his behalf, and, if the evidence is legally admissible, whether the Department laid the requisite foundation for its introduction.

The judgment of the trial court is reversed, and the case is remanded to the trial court.

Facts

Donald D. West died testate on November 3, 1998.The Department filed a claim for $13,434.77² against the estate of Mr. West on April 2, 1999, as authorized by section 473.398, RSMoCum. Supp. 1995, for medical benefits the Department had paid as Medicaid on Mr. West's behalf.The probate court heard the Department's claim against Mr. West's estate on September 1, 1999.At trial, the Department called two witnesses from the Department of Social Services, Division of Medical Services(DMS), to present records pertaining to Medicaid payments made in Mr. West's behalf: an income maintenance caseworker and an estate recovery analyst.The Department offered nine exhibits.Exhibit 1 was the claim documentation compiled by the DMS, which consisted of a billing statement, an attachment to the billing statement, the remittance advice, and a check register.The Estate objected to the introduction of the exhibits.Only one of the exhibits offered, a computer listing showing that the Department received no calls on the recipient's benefit notice, was admitted by the trial court into evidence.

The Estate requested judgment at the close of the Department's evidence.The probate court granted the Estate's motion for a directed verdict, finding that the Department failed to prove that benefits were expended on behalf of Donald West and entered judgment in favor of the Estate and against the Department.This appeal followed.

I.Confidentiality of Claim Documentation

The Estate objected to the introduction of records purportedly pertaining to the payment of state funds in decedent's behalf as Medicaid, contending that the information was protected as confidential information by sections 208.120.2and208.155.The court sustained the objection.The Department contends that the probate court erred in sustaining the Estate's objection to the introduction of the Department's claim documentation (Exhibit1) because the documentation of Medicaid payments made in behalf of the decedent was not confidential information under sections 208.120.1and208.155, and Exhibit 1 was, therefore, admissible.The Department asserts that the exhibit was not confidential for purposes of the hearing under either section because the claim documentation was directly connected with the administration of the Medicaid program and was, therefore, specifically excluded from the protection of either statute.The question presented is whether either section 208.120.1 or section 208.155 precluded introduction of decedent West's records of receipt of Medicaid benefits in the section 473.398 proceeding.

Three Missouri statutes are directly applicable to the issue presented.Section 473.398 authorizes the state to recover funds from the estate of a decedent who received Medicaid benefits.The statue states in part:

Upon the death of a person, who has been a recipient of aid, assistance, care, services, or who has had moneys expended on his behalf by the department of health, department of social services, or the department of mental health, or by a county commission, the total amount paid to the decedent or expended upon his behalf after January 1, 1978, shall be a debt due the state or county, as the case may be, from the estate of the decedent.The debt shall be collected as provided by the probate code of Missouri, chapters 472, 473, 474 and 475, RSMo.

Section 473.398.1, RSMoCum. Supp. 1995.Subsection 473.398.4 specifically allows recovery for assistance provided under 42 U.S.C. section 1396.Medicaid is federally funded and administered by the states according to state qualifying plans.42 U.S.C. section 1396(1992).The purpose of Medicaid is to provide medical assistance to needy persons whose income and resources are insufficient to meet the expenses of health care.McKenzie v. State of Missouri Dep't of Social Servs., Div. of Family Servs., 983 SW 2d 196, 198(Mo. App. E.D.1998).The federal statute imposes upon the states the burden of administering the program if the states receive the federal funds.Recipients of the medical care provided according to 42 U.S.C. section 1396 are to be families with dependent children and of aged, blind, or disabled individuals whose income and resources are insufficient to meet the costs of necessary medical services. section 1396.Rehabilitation and other services are to be provided to help such families and individuals attain or retain capability for independence or self-care.

Id.Sums made available under the statute are to be used for making payments to states that have submitted, and had approved by the Secretary, state plans for medical assistance.Id.

Both sections 208.120.1and208.155 restrict the use of records pertaining to recipients of medical benefits provided through the state's approved plan.Section 208.120.1 prohibits all officers and employees of the state of Missouri from "disclosing any information obtained by them in the discharge of their official duties relative to the identity of applicants for or recipients of benefits or the contents of any records, files, papers, and communications" with certain exceptions.The statute makes an exception for "purposes directly connected with the administration of public assistance."The statute also addresses confidentiality and admissibility in judicial proceedings:

[i]n any judicial proceedings, except such proceedings as are directly concerned with the administration of these programs, such information obtained in the discharge of official duties relative to the identity of applicants for or recipients of benefits, and records, files, papers, communications and their contents shall be confidential and not admissible in evidence.

Section 208.120.1.

Section 208.155, like section 208.120.1, protects certain information of recipientsof medical assistance and states: "All information concerning applicants and recipients of medical assistance shall be confidential, and any disclosure of such information shall be restricted to purposes directly connected with the administration of the medical assistance program."Section 208.155.

The first of two witnesses called by the Department to testify was a DMS income maintenance caseworker.She testified that she was custodian of Mr. West's income maintenance file.She stated that to respond to questions about payments to Mr....