Can a testator include an arbitration clause in their Will that forces beneficiaries to resolve disputes in a private arbitration forum rather than a New Jersey court? For the first time, the New Jersey Appellate Division has answered that question directly — and the answer is no.
In a case published on April 21, 2026, In re Estate of Samuel P. Hekemian, the Appellate Division held that an arbitration provision contained in a Last Will and Testament is unenforceable under New Jersey law.
Background: The Hekemian Family Estate
Samuel P. Hekemian died testate in August 2018, survived by his wife Sandra and their four adult sons: Peter, Jeffrey, Mark, and Richard. His 2002 Last Will and Testament (2002 LWT) appointed his son Peter and longtime advisor Edward G. Imperatore, Esq. as co-executors and co-trustees of three testamentary trusts established under the Will.
The 2002 LWT contained an arbitration clause providing that any dispute regarding the interpretation of the Will or its administration “shall be submitted for settlement by arbitration.” The clause declared arbitration to be “the exclusive remedy” for resolving such disputes and stated that the arbitrator’s decision “shall be final and binding upon all interested parties and shall not be appealable to any court of law.”
The same arbitration provision appeared in reciprocal Wills executed simultaneously in 2001 by Samuel and Sandra that were prepared by the same New York attorney. When Sandra and Richard later filed exceptions to the co-executors’ first intermediate accounting of the estate, the co-executors moved to compel arbitration.
A Second Look at the Same Arbitration Clause
This was not the first time the arbitration provision had been challenged. In an earlier unpublished opinion, the Appellate Division had affirmed the denial of a motion to compel arbitration of Richard’s request for an accounting, finding that the clause was not the product of mutual assent under traditional contract principles and that it failed to explain that Richard was relinquishing his right to bring a claim in court. At that time, however, the court stopped short of declaring the arbitration provision categorically unenforceable.
In the intervening period, Sandra joined the litigation and filed her own exceptions to the co-executors’ accounting. Unlike Richard, Sandra had received distributions under the 2002 LWT. The co-executors argued this distinguished her situation and that her participation in the Will’s benefits, combined with the execution of the reciprocal 2001 Wills, established the mutual assent necessary to compel her to arbitrate. The trial court rejected that argument and denied the motion. The co-executors appealed.
The Court’s Holding: Two Independent Grounds
The Appellate Division affirmed the trial court’s denial, but went further than the lower court by issuing a definitive ruling on a question of first impression: arbitration clauses in testamentary instruments are unenforceable under New Jersey law. The court rested its holding on two independent and mutually reinforcing grounds.
1. Lack of Mutual Assent
An agreement to arbitrate, like any contract, requires mutual assent — a knowing and voluntary waiver of the right to pursue claims in court. The court reaffirmed its earlier conclusion that the arbitration clause failed to explain, in clear and unambiguous terms, that interested parties were relinquishing their right to sue. Citing Atalese v. U.S. Legal Servs. Grp., L.P., 219 N.J. 430 (2014), the court emphasized that “the point is to assure that the parties know that in electing arbitration as the exclusive remedy, they are waiving their time-honored right to sue.”
The co-executors argued that Sandra’s simultaneous execution of a reciprocal Will containing the same arbitration clause demonstrated her assent. The court rejected this. While a meeting of the minds is not required for a Will to be effective — because a Will is a unilateral disposition of property, not a contract — that principle cuts in the opposite direction for arbitration purposes. Precisely because a Will is unilateral, neither Sandra nor any other interested party was afforded the opportunity to consider or elect to waive their right to proceed in court. The court was not satisfied that the simultaneous execution of reciprocal Wills, without more, established the kind of informed, knowing assent required for a valid arbitration agreement.
2. Inconsistency with the Probate Code
Even if the assent problem could be overcome, the court held that arbitration clauses in Wills are incompatible with New Jersey’s statutory framework for estate administration. The Probate Code, N.J.S.A. 3B:1-1 et seq., vests the Superior Court with comprehensive authority over Will disputes, trust administration, and fiduciary accountings. The court catalogued the relevant provisions, including but not limited to:
N.J.S.A. 3B:2-2 grants the Superior Court "full authority to hear and determine all controversies respecting wills, trusts[,] and estates, and full authority over the accounts of fiduciaries, and also authority over all other matters and things as are submitted to its determination under this title."
N.J.S.A. 3B:3-17 during probate, the Superior Court "may take depositions to wills[,] admit the same to probate, and grant . . . letters testamentary or letters of administration with the will annexed."
N.J.S.A. 3B:3-18 requiring that to "prove the transfer of any property or to nominate an executor, a will must be admitted to probate."
Against this backdrop, the court reaffirmed and expressly adopted what had been an observation in its prior unpublished opinion: “arbitration clauses that eliminate the courts’ expected role in resolving Will disputes are inconsistent with the detailed statutory scheme vesting the superior courts with the authority to adjudicate such issues.” Accordingly, enforcement of an arbitration clause in a testamentary instrument is contrary to both the Probate Code and New Jersey’s contract principles. The court held:
We conclude enforcement of an arbitration clause in a testamentary instrument is contrary to the court’s role underlying the Probate Code and inconsistent with our State’s contract principles.
What This Means for Estate Planning in New Jersey
The Hekemian decision settles a question that had been lingering in New Jersey estate practice for years. Estate planners and their clients should take note of several practical implications.
Arbitration clauses in Wills are unenforceable in New Jersey. Regardless of a testator’s intent, an arbitration provision in a Last Will and Testament cannot compel beneficiaries, heirs, or other interested parties to resolve their disputes outside of court. Any such provision should be considered a nullity.
Testamentary trusts are also covered. The court’s holding extends to disputes concerning trusts created under a Will, not merely the Will itself. The arbitration clause in the Will purported to cover disputes “regarding the interpretation of this Will and the trusts created hereunder” — both were held unenforceable.
The result is the same regardless of mutual assent. Even if a testator and their spouse executed reciprocal Wills containing identical arbitration clauses, and even if the surviving spouse received benefits under the Will, that is insufficient to establish the knowing, voluntary waiver of court rights required under Atalese.
Inter vivos trusts are a different question. The Hekemian decision addresses testamentary instruments — Wills and trusts created by Wills. Arbitration clauses in standalone inter vivos trusts, which are contractual instruments, may be treated differently.
Will disputes belong in court. Beneficiaries and interested parties who find themselves in estate disputes in New Jersey have a right to litigate those disputes in the Superior Court, Chancery Division, Probate Part — and a testator cannot take that right away through a provision buried in their Will.
A Practical Note for Families
For families navigating an estate dispute in New Jersey, the Hekemian decision is significant. If a co-executor or trustee attempts to invoke an arbitration clause in a Will to divert your dispute out of court, that clause is unenforceable. You are entitled to pursue your claims — whether exceptions to an accounting, removal of a fiduciary, or other relief — in the Superior Court under the full protections of New Jersey law.
For those in the estate planning process, this decision underscores the importance of working with an experienced New Jersey estate planning attorney who stays current with developments in the law. Estate planning documents should reflect the current legal landscape, not aspirational provisions that courts will not enforce.
It is one of the most common questions elder law attorneys hear: “If my parent goes on Medicaid, does the state get the house when they die?” The short answer is: it depends — and the details matter enormously.
New Jersey, like every other state, operates a Medicaid Estate Recovery Program (MERP). Under federal law, states are required to seek reimbursement from the estates of Medicaid recipients for long-term care costs paid on their behalf. The home — often the only significant asset remaining at death — is frequently the target. But the rules governing when and how New Jersey can pursue recovery are specific, and with proper planning, recovery can often be minimized or avoided entirely.
This post explains how New Jersey’s Medicaid estate recovery program works, what protections exist, and what families can do to protect a home and other assets.
What Is the Medicaid Estate Recovery Program?
The Medicaid Estate Recovery Program is administered in New Jersey by the Division of Medical Assistance and Health Services (DMAHS). Under both federal law and New Jersey law, DMAHS is required to seek reimbursement from the estates of deceased Medicaid beneficiaries for all Medicaid payments made on their behalf for services received at age 55 or older.
This is a point that catches families off guard. Medicaid’s eligibility asset rules during the recipient’s lifetime exempt the home from the $2,000 asset limit, provided the recipient intends to return home or a spouse or dependent relative lives there. But that exemption during life does not protect the home from recovery after death. The state is effectively deferring its claim until the recipient passes.
Recovery is not limited to nursing home care. Under New Jersey’s rules, DMAHS recovers for all Medicaid payments made on behalf of a recipient age 55 or older, including:
Nursing facility care
Home and community-based services, including MLTSS
Capitation payments (the cost of the Medicaid plan) made to managed care organizations on the recipient’s behalf — even if no specific services were rendered
Hospital and prescription drug costs related to long-term care
This broad scope means that recipients of home-based care programs are equally subject to estate recovery as nursing home residents. Families who chose home-based care assuming it carried no recovery risk should be aware of this.
What Does New Jersey Count as Part of the Estate?
New Jersey’s definition of “estate” for recovery purposes is broad — and broader than the probate estate in important ways. Under NJ DMAHS rules, an estate includes any property that belonged to the deceased at the time of death or at the moment prior to death, including:
The decedent’s home or share of a home
Bank accounts — whether solely or jointly held
Trusts and annuities
Stocks and bonds
Any other real or personal property
Critically, New Jersey’s rule extends to jointly held property. Even though a jointly held bank account or home typically passes to the surviving joint owner outside of probate — by operation of law — New Jersey treats the deceased recipient’s share as part of the recoverable estate. This is an area where New Jersey’s rules are particularly aggressive compared to some other states, which limit recovery to the probate estate only.
Families who added an adult child to a parent’s bank account or deed as a matter of convenience should understand that this titling arrangement may not protect those assets from MERP. See my earlier post on joint bank accounts and Medicaid eligibility for how account titling creates problems both during the Medicaid application process and after death.
When Will New Jersey Not Pursue Recovery?
Recovery is not automatic upon death. New Jersey is prohibited from pursuing estate recovery — or must defer its claim — under the following circumstances:
Surviving Spouse
DMAHS will not pursue recovery while a surviving spouse is alive. Recovery is deferred until after the spouse’s death. At that point, New Jersey may seek recovery from whatever remains in the estate — including assets that passed from the Medicaid recipient to the surviving spouse. This is an important planning consideration, particularly for couples who did not pursue Medicaid planning before the first spouse’s death.
Surviving Child Under 21
Recovery is deferred while the recipient has a surviving child under the age of 21. Once the child reaches 21, or upon the child’s earlier death, DMAHS may pursue recovery from remaining estate assets.
Blind or Permanently Disabled Child
Recovery is deferred while the recipient has a surviving child who is blind or permanently and totally disabled under Social Security standards. Recovery may be pursued after that child’s death or if the disability no longer applies.
Cost-Effectiveness
DMAHS has discretion not to pursue recovery if it determines that doing so would not be cost-effective. In practice, this exception applies to very small estates where the administrative cost of collection would outweigh the recovery amount.
The Hardship Waiver: Narrow in New Jersey
Federal law requires all states to offer a hardship waiver — a mechanism by which the estate representative can seek to have DMAHS waive or reduce its recovery claim based on undue hardship to the beneficiaries. Some states have adopted generous hardship waiver standards. New Jersey has not.
⚠️ Important: New Jersey’s hardship waiver rules are among the strictest in the country. Under N.J.A.C. 10:49-14.1(h), New Jersey recognizes hardship only in very limited circumstances: when the deceased’s property is the sole source of income for one or more surviving family members, and pursuing recovery would likely cause those survivors to become eligible for public assistance or Medicaid. A waiver may also be considered if it would not be cost-effective to pursue recovery.
This standard is significantly narrower than the federal guidance, which suggests states also waive recovery against homes of modest value, income-producing family farms or businesses, and other compelling circumstances. New Jersey has not adopted those broader protections.
The practical consequence is that most NJ families who would otherwise qualify for a hardship waiver in other states will not qualify in New Jersey. An adult child who lived in and cared for a parent’s home, for example, would not qualify for a waiver simply because they stand to lose their residence — unless they can demonstrate they have no other source of income and would be driven to public assistance.
How New Jersey Places and Enforces Liens
When a Medicaid recipient dies and the conditions for recovery are met — no surviving spouse, no qualifying child — DMAHS will seek to be repaid up to the amount of all Medicaid assistance provided for services received at age 55 or older, including all capitation payments.
New Jersey does not typically force the immediate sale of a home to satisfy a MERP claim. However, there is an important exception to the deferral rule for family members residing in the home. Under New Jersey’s rules, if a family member of the deceased Medicaid beneficiary had continuously resided in the home prior to the beneficiary’s death, and the home was the beneficiary’s primary residence and remains the family member’s primary residence, DMAHS may record a lien against the property but will not enforce it until:
The property is voluntarily sold
The resident family member dies
The resident family member vacates the property
This deferral can provide meaningful relief for a family member — often an adult child caregiver — who has been living in the home. But it is a deferral, not a waiver. The lien remains. When any of the triggering conditions occur, DMAHS will pursue its claim from whatever value remains in the property.
Life Insurance, Annuities, and Burial Trusts
Life Insurance
Proceeds from life insurance policies are generally considered assets of the named beneficiaries — not the estate — and are therefore not subject to recovery, provided a beneficiary other than the estate is named. However, if a named beneficiary predeceases the Medicaid recipient and the estate becomes the default beneficiary, those proceeds become recoverable.
Annuities
Annuities that were not liquidated prior to Medicaid eligibility must name the State of New Jersey as the remainder beneficiary in the primary position — or secondary position if there is a community spouse or qualifying child. Upon the recipient’s death, the state collects any remaining principal or income from the annuity before any other beneficiary receives a distribution.
Irrevocable Funeral Trusts
Under New Jersey law, any funds remaining in an irrevocable funeral trust after reasonable funeral expenses have been paid must be forwarded to DMAHS if the deceased received Medicaid or public assistance benefits. This applies equally to burial insurance policies.
What the Estate Is Required to Do
The obligation to notify DMAHS falls on whoever is handling the estate — whether an executor, administrator, or family member. Under New Jersey’s rules, the estate representative must contact DMAHS in writing as soon as possible after the Medicaid recipient’s death to determine whether a claim exists. This notice must be sent before any assets are distributed to creditors or heirs (with the exception of reasonable funeral expenses).
Distributing estate assets to heirs before satisfying a DMAHS claim can expose the executor or administrator to personal liability. Written notice should be sent to:
DMAHS Office of Legal and Regulatory Affairs Attn: Estates PO Box 712 — Mail Code #6 Trenton, NJ 08625 Phone: 609-588-3016
How to Protect Your Home and Assets From Estate Recovery
The most important thing to understand about Medicaid estate recovery is that it is largely avoidable with proper advance planning. The strategies that work best require time — ideally years — before a Medicaid application is filed.
Medicaid Asset Protection Trust (MAPT): Transferring a home or other assets into an irrevocable Medicaid Asset Protection Trust removes those assets from the recoverable estate, provided the transfer occurs more than five years before a Medicaid application. Assets held in a properly structured MAPT are not subject to MERP because they are no longer owned by the Medicaid recipient at death. This is the single most effective tool for protecting a home from estate recovery.
Life Estate Deed: A life estate deed transfers remainder interest in the home to children or other heirs while the owner retains the right to live there for life. However, this type of transfer must be made more than 5 years before the first Medicaid application. This strategy should only be used if the plan is to stay in the home permanently. If the Medicaid recipient vacates the home or if it is sold, it may affect the home's exempt status under Medicaid rules or be considered a receipt of assets. There are nuances to this approach and it is not appropriate in all situations.
Spousal planning: A home transferred to a community spouse during the Medicaid recipient’s lifetime can be considered an exempt asset. Proper titling and estate planning for the community spouse can limit what remains in a recoverable estate at the survivor’s death. There are also potential pitfalls to be aware of such as the unexpected death of the community spouse before the Medicaid recipient.
Beneficiary designations and joint ownership: Unlike some states, New Jersey reaches jointly held property and certain non-probate assets for recovery purposes. Families should not assume that a joint account or payable-on-death designation will shield assets from MERP in New Jersey.
For a broader discussion of Medicaid planning strategies available to married couples, including some that require a more difficult conversation, see my post on Divorce as a Medicaid Planning Strategy in New Jersey.
Final Thoughts
New Jersey’s Medicaid Estate Recovery Program is real, it is active, and it reaches further than most families expect — including jointly held property, home-based care recipients, and assets that pass outside of probate. The hardship waiver is available in theory but rarely granted in practice under New Jersey’s narrow standards. The families who successfully protect their homes and assets are almost always the ones who planned ahead. If you or a loved one is aging or dealing with health concerns, the question of Medicaid estate recovery is worth discussing with an elder law attorney now — before a nursing home admission, before a Medicaid application, and before it is too late to take meaningful action.
Your spouse is rushed to the hospital. The doctors need to make critical decisions about their treatment. Who has the legal right to make those decisions? Who has access to information? And what happens when adult children — or stepchildren — disagree with what you want?
These are not hypothetical questions. They play out in New Jersey hospitals and emergency rooms regularly, and the answers depend almost entirely on whether the incapacitated person planned ahead. This post explains the legal framework governing spousal rights in a medical emergency in New Jersey, and why the absence of proper documents can turn a medical crisis into a legal one.
The Fundamental Right to Control Your Own Medical Care
New Jersey law starts from a clear premise: every competent adult has a fundamental right to make their own health care decisions, including the right to refuse treatment. This right does not disappear simply because a person becomes ill or loses the ability to speak for themselves. The New Jersey Advance Directives for Health Care Act, N.J.S.A. 26:2H-53 et seq., is built around the principle that a person’s documented wishes must be honored even when they can no longer communicate them directly.
The problem arises when a person loses decision-making capacity — whether temporarily due to a medical procedure, or permanently due to a stroke, dementia, or traumatic injury — and has not left clear instructions or designated someone to act on their behalf. In that vacuum, conflict among family members is not just possible. It is common.
Scenario 1: Your Spouse Has an Advance Directive
An Advance Directive is the umbrella term under New Jersey law for two related documents: a Proxy Directive (Healthcare Proxy or Durable Power of Attorney for Healthcare), which designates a specific person to make medical decisions, and an Instruction Directive (Living Will), which sets out the patient’s specific wishes regarding treatment. The basics of Living Wills are covered in an earlier post: Understanding Living Wills: Why They Matter and How to Create One.
When a valid Advance Directive is in place and designates a Health Care Representative, that person — and that person alone — has legal authority to make medical decisions once the patient is determined to lack decision-making capacity. If the spouse is designated as the Health Care Representative, they have clear legal authority under N.J.S.A. 26:2H-61. Healthcare providers are required to treat the Health Care Representative’s decisions as if they came from the patient directly. Adult children, stepchildren, siblings, and other family members have no legal standing to override those decisions, regardless of how strongly they feel about the matter.
One critical note: under N.J.S.A. 26:2H-57(c), a designation of a spouse as Health Care Representative is automatically revoked upon divorce or legal separation. If your spouse’s Advance Directive was executed during a prior marriage and never updated, the former spouse no longer has authority — and there may be no designated representative at all.
Scenario 2: Your Spouse Has No Advance Directive
This is where the situation becomes significantly more complicated. When there is no Advance Directive, New Jersey does not have a formal statutory surrogate decision-making law that automatically grants the spouse legal authority to make medical decisions. Instead, the law operates through a combination of common practice, hospital or medical facility policy, and the general principles of the NJ Advance Directives Act.
In practice, New Jersey hospitals and healthcare providers follow a default hierarchy when a patient lacks both capacity and an Advance Directive. The spouse or domestic partner is generally treated as the presumptive decision-maker first, followed by adult children, then parents, then other next of kin. However, this default hierarchy is not codified as a rigid legal rule in the same way it is in some other states. It is a practical framework that healthcare providers follow, and it can break down when family members disagree — particularly when adult children from a prior relationship contest the spouse’s authority. When disputes are not resolved amicably, this often will lead to legal action.
When Children and Stepchildren Get Involved
This is the most emotionally charged and legally murky area of healthcare decision-making, and it arises more frequently in blended families than most people expect.
Consider a common scenario: a man remarries later in life. He has adult children from his first marriage who have a complicated relationship with his new wife. He is hospitalized following a stroke and cannot communicate his wishes. He has no Advance Directive. His wife believes he would not want aggressive intervention; his adult children disagree and want every available treatment pursued. Who wins?
Without an Advance Directive, there is no definitive legal answer under New Jersey law. In the absence of a designated Health Care Representative, N.J.S.A. 26:2H-64 provides that an Instruction Directive (Living Will) alone — without a named proxy — can guide treatment decisions. But if there is no document at all, the decision-making process defaults to the attending physician, guided by the patient’s known preferences, family input, and the hospital’s ethics committee if necessary.
Stepchildren have no automatic legal standing under New Jersey law to make healthcare decisions for a step-parent. Neither do biological children, for that matter, if a spouse has been designated as Health Care Representative. But in the absence of any legal designation, healthcare providers must navigate competing family voices without clear legal authority to resolve the dispute — which can result in delayed treatment, institutional ethics committee referrals, or in many cases, court-ordered guardianship.
How New Jersey Handles Family Disputes
The New Jersey Advance Directives for Health Care Act contains a dispute resolution mechanism under N.J.S.A. 26:2H-66. When disagreements arise about a patient’s care — whether over the interpretation of an Advance Directive, the patient’s decision-making capacity, or the appropriate course of treatment — any interested party can invoke the dispute resolution process established by the healthcare institution. Most hospitals in New Jersey maintain ethics committees for exactly this purpose.
In cases where the dispute cannot be resolved through the hospital’s internal process, or where there is no appropriate decision-maker available, a court can intervene and appoint a guardian under New Jersey’s guardianship statutes. Guardianship proceedings in this context are filed in the Superior Court, Chancery Division, Probate Part, in the county where the incapacitated person resides.
Even before the question of decision-making authority arises, a spouse may face a more immediate obstacle: access to medical information. Under the federal Health Insurance Portability and Accountability Act (HIPAA), healthcare providers are prohibited from disclosing a patient’s medical information without authorization. In an emergency, providers will typically share information with a spouse as the presumptive next of kin. But in situations where family relationships are contested or communication is disrupted, a spouse may find themselves unable to get basic information about their partner’s condition.
A HIPAA authorization — a separate document designating who may receive medical information — can address this gap. Many comprehensive Advance Directive forms include one. If your spouse’s Advance Directive does not include a HIPAA authorization, it is worth asking your attorney about adding one.
What Every New Jersey Resident Should Do
The good news is that all of the scenarios described above are preventable with proper planning. Here are steps that everyone — especially people in blended families — should take:
A Proxy Directive (Healthcare Proxy): Designates a specific person to make medical decisions and eliminates any ambiguity about who is in charge. Should include an alternate designee in case the primary is unavailable.
An Instruction Directive (Living Will): Documents the patient’s specific wishes about life-sustaining treatment, artificial nutrition, resuscitation, and other critical decisions. Reduces the burden on the Health Care Representative and minimizes the grounds for family disputes.
A HIPAA Authorization: Ensures that designated individuals can receive medical information even in ambiguous situations.
A conversation with your family: Documents are only as effective as the communication surrounding them. Adult children — biological and step — should know what documents exist, how to access the originals, who is designated, and what the patient’s wishes are. Surprises at the hospital are often the root cause of conflict.
Regular review and updates: Advance Directives should be reviewed after major life events — a new marriage, a divorce, a serious diagnosis, or a change in the patient’s treatment preferences. A document executed ten years ago may no longer reflect current wishes or circumstances.
The State of New Jersey provides free Advance Directive forms through the New Jersey Department of Health. These are available at:
While these forms are legally valid when properly filled out, signed and witnessed, they are not a substitute for individualized legal counsel — particularly for blended families, individuals with complex medical histories, or anyone whose family dynamics suggest the possibility of conflict.
Final Thoughts
A medical emergency is not the time to be resolving questions about who has legal authority to make decisions. By the time those questions arise, it is often too late to execute new documents, and the resulting disputes can cause lasting damage to family relationships on top of the medical crisis itself.
The rights of a spouse in a medical emergency are clear when proper documents are in place — and deeply uncertain when they are not. If you, your spouse or any adult family members have not yet executed Advance Directives, or if your existing documents are outdated, contact your attorney to schedule a consultation.
A decision from the New Jersey Appellate Division published June 17, 2025 (In the Matter of G.W.) has clarified a critical and previously unsettled area of law concerning public benefit liens. The court held that a lien issued by the Division of Developmental Disabilities (DDD) is immediately enforceable, while a Medicaid lien cannot be collected until the beneficiary’s death — a distinction with significant consequences for estate planning.
The Background
Gabrielle W., an adjudicated incapacitated adult, received residential services funded by both DDD and Medicaid. When she inherited $600,000 from her sister’s estate, Arc of Bergen and Passaic Counties, her court-appointed property guardian, sought to protect her Medicaid eligibility by transferring those funds to a special needs trust. But standing in the way was a $1,052,304 lien from DDD for the cost of her care — a lien DDD sought to enforce immediately.
The trial court declined to enforce the DDD lien, ruling instead that Medicaid’s future estate recovery rights had priority. The court reasoned it was in Gabrielle’s best interest to preserve her Medicaid eligibility and protect the trust. But on appeal, the Appellate Division disagreed.
The Court's Holding
The Appellate Division reversed the lower court’s order, emphasizing that DDD liens are enforceable immediately under N.J.S.A. 30:4-80.1. These liens attach to the property of a living person who receives services from DDD. On the other hand, Medicaid liens can only be asserted posthumously, pursuant to N.J.S.A. 30:4D-7.2, and only against the estate of the deceased Medicaid recipient.
The court concluded there is no statutory conflict: both liens can coexist, but they operate on distinct timelines. In the case of a living person like Gabrielle, DDD had the only legally viable lien. Medicaid’s recovery rights would not ripen until Gabrielle’s death.
Why This Matters
This case is a clear warning to guardians, trustees, and estate planners: Inherited assets cannot be shielded from DDD repayment obligations simply by invoking Medicaid's future claim rights. If a client receives services from DDD and comes into money, the DDD lien must be addressed promptly — either by repayment or through the statutory compromise process. The court also made clear that a “best interests” argument cannot override a legislatively mandated lien. Courts must enforce the statutes as written.
Planning Tip
If you have a loved one who receives public benefits like Medicaid or services from DDD, careful estate planning is essential. Leaving them an inheritance outright — even with good intentions — can jeopardize their benefits and trigger immediate repayment obligations. Instead, consider using special needs trusts or other protective planning tools to ensure their continued eligibility and long-term care without exposing them to liens or disruptions in services.
The G.W. case illustrates precisely what happens when protective planning is absent. Gabrielle's sister died intestate — without a will — which meant the $600,000 passed to Gabrielle outright under New Jersey's laws of intestate succession. There was no will directing those funds into a Special Needs Trust, no advance coordination with an elder law attorney, and no mechanism to receive the inheritance in a protected form. The result was an immediate lien enforcement proceeding that consumed the entirety of the inheritance and left nothing for Gabrielle's ongoing care needs.
Had Gabrielle's sister executed a will with proper special needs planning, she could have directed her estate — or the portion intended for Gabrielle — into a third-party Special Needs Trust. Unlike a first-party trust funded with the beneficiary's own assets, a third-party SNT is established with someone else's money and carries no Medicaid payback requirement at death. Gabrielle would have received the benefit of those funds without triggering the DDD lien, and without disrupting her Medicaid eligibility.
This is one of the most important and underappreciated points in elder law and disability planning: the person doing the planning is often not the disabled individual, but the family member who intends to leave them something. A parent, sibling, or other relative who has a loved one receiving public benefits should have a will — and that will should account for the beneficiary's disability. Leaving assets outright to a Medicaid or DDD recipient, however well-intentioned, can do more harm than good.
When most people hear the word “divorce,” they think of a relationship in crisis. But for some New Jersey couples facing the catastrophic cost of long-term care, divorce is not a sign of a failing marriage — it is a deliberate financial planning strategy designed to protect a healthy spouse from impoverishment while allowing the other spouse to qualify for Medicaid.
It sounds counterintuitive. It raises profound emotional and ethical questions. And it is not a strategy that is right for most families. But in the right circumstances, a so-called “Medicaid divorce” is a legitimate legal strategy under New Jersey law.
Why Married Couples Face a Unique Medicaid Challenge
Medicaid treats married couples differently than single individuals when assessing eligibility for long-term care benefits. When one spouse applies for Medicaid to cover nursing home or home-based long-term care, Medicaid looks at the combined assets of both spouses — regardless of whose name the assets are in — and requires a spend-down to very low levels before the institutionalized spouse qualifies.
New Jersey does provide some protection for the healthy spouse, known as the “Community Spouse.” The Community Spouse Resource Allowance (CSRA) permits the Community Spouse to retain a portion of the couple’s combined countable assets. For 2026, the CSRA in New Jersey ranges from a minimum of $32,532 to a maximum of $162,660, depending on the total assets. The community spouse is also entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) to cover monthly living expenses — currently $2,643.75 per month.
For couples with modest assets, the CSRA and MMMNA may provide adequate protection. But for couples with significant savings these protections may still leave the community spouse facing financial hardship after a Medicaid spend-down.
What Is a Medicaid Divorce?
A Medicaid divorce is exactly what it sounds like: the couple obtains a real, legal divorce for the primary purpose of restructuring their assets. If done properly the divorce allows the Medicaid applicant spouse to qualify for Medicaid while allowing the healthy spouse to retain a larger share of the marital estate than Medicaid’s spousal protection rules would otherwise permit.
This is not a separation, a legal fiction, or a paper transaction. New Jersey requires an actual divorce. The parties must satisfy the grounds for divorce under New Jersey law — most commonly irreconcilable differences under N.J.S.A. 2A:34-2(i), which requires only that the parties have experienced irreconcilable differences for a period of six months. Establishing grounds is generally straightforward. The harder questions involve asset division, legal capacity, and Medicaid’s scrutiny of the resulting property settlement.
How Divorce Can Help: The Mechanics
Under New Jersey matrimonial law, divorce entitles each spouse to an equitable distribution of marital assets. “Equitable” does not necessarily mean equal — courts consider a range of factors, including each spouse’s financial needs, health, and ability to earn income. In the context of a Medicaid divorce, the parties’ attorneys will negotiate a property settlement agreement (PSA) that awards the healthy spouse a disproportionate share of the marital estate — often well above 50 percent — based on their demonstrated need to support themselves independently.
Once the divorce is finalized and assets are distributed pursuant to a court order, Medicaid should treat the applicant spouse’s eligibility as a single individual. The assets awarded to the now ex-spouse are no longer counted when applying for Medicaid. If the applicant spouse’s retained assets fall below Medicaid’s $2,000 limit, they may qualify for long-term care Medicaid.
Critically, under New Jersey law, a court order transferring assets to the community spouse will supersede Medicaid’s spousal resource rules. This is the legal foundation that makes Medicaid divorce viable in New Jersey: the court’s equitable distribution order takes precedence over Medicaid’s default calculation of spousal assets.
The Transfer Penalty Risk: Proceed with Caution
The most significant legal risk in a Medicaid divorce is the transfer penalty. Medicaid imposes a look-back period of 60 months, during which any asset transfers for less than fair market value are penalized with a period of ineligibility. A divorce property settlement that awards the community spouse an outsized share of marital assets could be characterized by Medicaid as a disqualifying transfer — unless the division is properly structured and supported by documented findings.
New Jersey Medicaid does not simply accept a property settlement agreement at face value. The agency will scrutinize the terms of the divorce decree and the underlying rationale. A PSA that reads like a Medicaid planning document, with no independent factual basis for the proposed distribution, is unlikely to survive that scrutiny.
This is why Medicaid divorce requires coordinated representation by both a matrimonial attorney and an experienced elder law attorney. The two bodies of law must work together, and a misstep in either domain can result in a significant period of Medicaid ineligibility at precisely the moment care is most urgently needed.
The Legal Capacity Question
One of the most difficult issues in Medicaid divorce planning is legal capacity. When a spouse is suffering from a condition that impairs cognitive functioning, their ability to participate in — and consent to — divorce proceedings must be carefully evaluated before any action is taken.
If the Medicaid applicant spouse lacks capacity, the question becomes whether a Power of Attorney gives the agent authority to pursue or consent to divorce on their behalf. Most “standard” Powers of Attorney in New Jersey do not explicitly authorize the agent to file for or consent to divorce proceedings. This is a significant gap. Families contemplating Medicaid divorce as a potential future strategy should ensure that their Power of Attorney documents are drafted broadly enough to address this contingency — or that the question is addressed before capacity is lost.
If no Power of Attorney is in place and the applicant spouse lacks capacity, it may be necessary to pursue guardianship before any matrimonial proceedings can commence. That adds time, cost, and complexity to an already complicated situation.
The Emotional Reality
No discussion of Medicaid divorce is complete without acknowledging what it asks of a couple. For a husband and wife who have been together for many years, the idea of filing for divorce — even “on paper” — can feel like a profound betrayal of the relationship, regardless of the financial logic. Many families ultimately decide against it for this reason alone, and that is a completely legitimate choice.
Some couples find it helpful to think of the divorce as a legal and financial restructuring that does not change the nature of their relationship. They may continue to care for one another as spouses in every meaningful sense. The legal status changes; the relationship does not have to. But this reframing does not work for everyone, and it should never be minimized or dismissed.
Divorce can also impact Social Security survivor benefits, inheritance rights, life insurance beneficiary designations, and existing estate plans. Every one of these downstream consequences needs to be evaluated before proceeding.
Alternatives Worth Considering First
Before pursuing a Medicaid divorce, families should work with an elder law attorney to evaluate whether less disruptive alternatives can achieve comparable results. Depending on the facts, these may include:
Irrevocable Medicaid trusts: Assets transferred to an irrevocable trust more than five years before a Medicaid application are not counted.
Convert Countable Assets to Exempt Assets: Converting countable assets into exempt ones — such as home improvements, paying off a mortgage, purchasing a prepaid funeral trust, or buying a Medicaid-compliant annuity — can reduce countable assets without a transfer penalty.
Final Thoughts
Medicaid divorce is one of the most emotionally complex strategies in the elder law toolkit. It is also, in the right circumstances, a legally sound and financially significant option that can protect a community spouse from genuine impoverishment. The key words are “right circumstances.” This is not a strategy to pursue without extensive legal counsel from attorneys who understand both New Jersey matrimonial law and Medicaid eligibility rules. The financial, legal, and emotional stakes are too high for anything less. If you are facing a situation where one spouse needs long-term care and you are concerned about what that means for the other, contact your attorney to discuss options.
Families planning for a loved one with a disability in New Jersey often face the same question: should we set up a Special Needs Trust, open an ABLE account, or both? The answer depends on the individual’s age, the amount of money involved, and the kinds of expenses you need to cover.
Both tools are designed to preserve eligibility for public benefits like Medicaid and Supplemental Security Income (SSI) while allowing a person with disabilities to have access to additional resources. I’ve previously covered SSI Medicaid eligibility in New Jersey in detail. I’ve also given an overview of NJ ABLE accounts and how they can help a family save, while preserving SSI eligibility. This post focuses on Special Needs Trusts and ABLE accounts, and how to choose between the two tools — or use them together.
What Is a Special Needs Trust?
A Special Needs Trust (SNT) is a legal trust designed to hold assets for the benefit of a person with a disability without disqualifying them from means-tested government benefits. The key is that the trust — not the individual — owns the assets, so they do not count toward Medicaid or SSI resource limits.
There are two main types of Special Needs Trusts in New Jersey:
First-Party: Funded with the beneficiary’s own assets — for example, a personal injury settlement or an inheritance received directly. Must be established before the beneficiary turns 65. Upon the beneficiary’s death, Medicaid must be reimbursed for benefits paid.
Third-Party: Funded with assets belonging to someone other than the beneficiary — typically a parent, grandparent, or other family member. No age restriction. No Medicaid payback requirement upon death, which makes this the preferred option for family estate planning.
A trustee — often a family member, attorney, or professional trust company — manages the trust and makes distributions on the beneficiary’s behalf. Distributions must supplement, not replace, government benefits. This means trust funds generally cannot be used for food or shelter without impacting SSI and Medicaid eligibility.
What Is an ABLE Account?
An ABLE account (Achieving a Better Life Experience) is a tax-advantaged savings account available to individuals whose disability began before age 46 (increased from 26 effective January 1, 2026). New Jersey’s program is administered through NJ ABLE. For a full breakdown of eligibility and benefits, see my earlier post: NJ ABLE Accounts: Preserving Benefits for Individuals with Disabilities.
Key features of an ABLE account:
Funds are not counted as assets for Medicaid or SSI purposes (up to $100,000 for SSI)
Annual contribution limit: $20,000 in 2026 (with additional contributions allowed under the ABLE to Work Act for working beneficiaries)
Total account balance cap: $305,000 in New Jersey
The account holder — or their legal representative — controls the account directly
Can be used for a broad range of qualified disability expenses, including housing, transportation, education, health, and more
When a Special Needs Trust Makes More Sense
A Special Needs Trust is typically the better choice when:
The beneficiary is receiving a large sum — such as an inheritance, personal injury settlement, or life insurance proceeds — that exceeds ABLE account contribution or balance limits
The disability onset was at age 46 or older, making the individual ineligible for an ABLE account
A family member wants to leave money to a loved one with disabilities as part of their estate plan (a third-party SNT is the preferred vehicle here)
Complex financial management is required and a professional trustee is needed
The family wants to avoid the Medicaid payback requirement upon death — only possible with a third-party SNT
When an ABLE Account Makes More Sense
An ABLE account is typically the good choice when:
The individual’s disability began before age 46
The goal is to set aside modest amounts for day-to-day supplemental expenses without the cost and complexity of a trust
The individual wants direct control over their own funds
The family wants a simple, low-cost planning tool to complement existing benefits
Contributions from family members, friends, or employers are expected over time
Can You Use Both?
Yes — and for many families, using both tools together is an effective strategy. A common approach:
Establish a third-party Special Needs Trust in the parents’ estate plan to receive larger inheritances or life insurance proceeds
Open an ABLE account for the beneficiary to handle smaller, recurring disability-related expenses with greater flexibility and direct access
The two tools complement each other well. The SNT handles larger, longer-term assets with professional oversight. The ABLE account provides the beneficiary with day-to-day financial autonomy without jeopardizing benefits.
Important Caution: Get it Right from the Start
Both Special Needs Trusts and ABLE accounts involve rules that — if not followed carefully — can inadvertently disqualify a person from Medicaid or SSI. With a Special Needs Trust in particular, improper distributions (for example, paying for food or rent directly) can reduce SSI benefits dollar for dollar.
Before establishing either tool, consult with a New Jersey elder law or special needs planning attorney to ensure the structure is right for your family’s situation.
Final Thoughts
There is no one-size-fits-all answer. The right tool depends on your loved one’s age, the assets involved, and your long-term planning goals. For families with a child or adult with disabilities in New Jersey, both a Special Needs Trust and an ABLE account deserve a place in the conversation. Read my earlier post on NJ ABLE Accounts for a deeper dive into how ABLE accounts work.
