Forest v. Division of Medical Assistance and Health Services - Medicaid Lien
Summary
The New Jersey Superior Court Appellate Division affirmed a lower court's decision denying a request to invalidate a Medicaid lien placed by the Division of Medical Assistance and Health Services (DMAHS) on property. The court found that DMAHS correctly interpreted statutory and regulatory law regarding estate recovery.
What changed
The New Jersey Superior Court Appellate Division affirmed the denial of a request to invalidate a Medicaid lien placed by the Division of Medical Assistance and Health Services (DMAHS) on property owned by the deceased beneficiaries' estate. The plaintiffs, beneficiaries under the will, sought to declare the lien invalid, but the court found the trial court correctly interpreted applicable statutory and regulatory law concerning estate recovery. The Medicaid program had expended $415,501.30 for medical care provided to the beneficiary.
This decision affirms the DMAHS's ability to place liens on property for Medicaid expenditures. While this specific case is non-precedential, it reinforces the established estate recovery process for Medicaid beneficiaries in New Jersey. No specific compliance actions are required for regulated entities based on this non-precedential opinion, but it serves as a reminder of DMAHS's recovery rights.
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March 19, 2026 Get Citation Alerts Download PDF Add Note
Mary D. Forest v. Division of Medical Assistance and Health Services
New Jersey Superior Court Appellate Division
- Citations: None known
- Docket Number: A-1344-24
Precedential Status: Non-Precedential
Combined Opinion
NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
This opinion shall not "constitute precedent or be binding upon any court ." Although it is posted on the
internet, this opinion is binding only on the parties in the case and its use in other cases is limited . R. 1:36-3.
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-1344-24
MARY D. FOREST and
TARKETIA AJAYI,
Plaintiffs-Appellants,
v.
DIVISION OF MEDICAL
ASSISTANCE AND HEALTH
SERVICES,
Defendant-Respondent.
Argued February 25, 2026 – Decided March 19, 2026
Before Judges Mayer and Gummer.
On appeal from the Superior Court of New Jersey,
Chancery Division, Essex County, Docket No.
C-000172-24.
John L. Pritchard argued the cause for appellants.
Barkha Patel, Deputy Attorney General, argued the
cause for respondent (Jennifer Davenport, Attorney
General, attorney; Sookie Bae-Park, Assistant Attorney
General, of counsel; Barkha Patel, on the brief).
PER CURIAM
Plaintiffs Mary D. Forest and Tarketia Ajayi, beneficiaries under the will
of Clerveaux Benoit, appeal a judgment denying their request to declare invalid
a lien defendant Division of Medical Assistance and Health Services (DMAHS)
placed on property that had been owned by Clerveaux and his wife Philomene
Benoit.1 Philomene was a Medicaid beneficiary who predeceased Clerveaux.
Plaintiffs also appeal an order denying their counsel-fee application. Because
the trial court correctly interpreted applicable statutory and regulatory law, we
affirm.
I.
Clerveaux and Philomene acquired title to the property at issue in 1986
and held it as tenants by the entirety. Philomene was a Medicaid beneficiary
from August 1, 2003, until her death on May 3, 2012. The New Jersey Medicaid
program expended $415,501.30 for medical care and services provided to her.
DMAHS's estate recovery information system indicates DMAHS sent notices on
June 29, 2012, August 16, 2012, and November 14, 2012, to the property .
According to DMAHS's counsel, copies of those notices no longer exist due to
1
Because Clerveaux and Philomene had the same last name, we refer to them
by their first names for ease of reading. In doing so, we mean no disrespect.
A-1344-24
2
the passage of time, but the notices would have contained references to
DMAHS's claim of a Medicaid lien and requests for information regarding the
assets of Philomene's estate and whether she had a surviving spouse. The estate
recovery information system was updated on January 11, 2013, to indicate
Philomene had a surviving spouse.
In early April 2019, DMAHS received a letter from Tamarra Henry, who
identified herself as Philomene's daughter and the executor of her estate.
Henry's letter acknowledged Philomene had received Medicaid benefits and the
family had been "told by a Medicaid representative back in 2012 that there was
a possibility a lien would be placed on [Philomene's] home to cover the
healthcare costs she incurred" and "that Medicaid would wait until the surviving
spouse, [her] father, Clerveaux . . . passed away before any action would be
taken." In the same letter, she informed DMAHS Clerveaux had died in June
2017 and inquired about the status of the lien.
In an April 11, 2019 letter, DMAHS advised Henry it was asserting a
claim against Philomene's estate in the amount of $415,501.30 and was filing a
lien pursuant to N.J.S.A. 30:4D-7.2(a). DMAHS also informed Henry that due
to the lien, "any disposal of real property cannot occur without the consent or
cooperation of [DMAHS]." On May 13, 2019, DMAHS sent Henry a copy of a
A-1344-24
3
lien claim it had docketed in the Superior Court on May 13, 2019. DMAHS's
lien specifically referenced the property, the cost of the benefits Philomene had
received, and N.J.S.A. 30:4D-7.2 to -7.6.
On August 1, 2024, plaintiffs filed a verified complaint against DMAHS
and an application for an order to show cause. Identifying themselves as
beneficiaries under Clerveaux's will, plaintiffs sought a judgment declaring the
lien legally ineffective against Clerveaux's estate, the property, or the proceeds
of the sale of the property. According to plaintiffs, the property had been sold
in 2021, and proceeds of the sale were held in escrow due to the lien. Plaintiffs
also sought a counsel-fee award. In the verified complaint, plaintiffs
acknowledged Philomene had received benefits from DMAHS but asserted
DMAHS's lien to recover the costs of those benefits was not effective against
the property because Clerveaux was the property's sole owner and "sole
surviving tenant by the entireties."
The court entered an order to show cause. DMAHS opposed plaintiffs'
application. The court heard argument, asked for supplemental briefing, and
heard argument again after receiving the parties' submissions.
On November 13, 2024, the court placed on the record a decision denying
plaintiffs' application. The court rejected plaintiffs' assertion DMAHS had not
A-1344-24
4
properly recorded or provided notice of the lien. The court also rejected
plaintiffs' argument DMAHS was precluded from using the property to recoup
Philomene's Medicaid costs because when Philomene died, ownership of the
property had passed to Clerveaux as the surviving tenant by the entirety. The
court concluded that "any other interpretation [of the applicable statutes and
regulations] would wholly upend what is a necessary service benefit that is given
to people who need it at the time they most need it." The court memorialized
its decision in a December 10, 2024 judgment.
The court permitted supplemental submissions regarding plaintiffs'
counsel-fee application. The court denied the application in a December 5, 2024
order with an attached statement of reasons. The court found plaintiffs were not
prevailing parties and were not entitled to a fee award under Rule 4:42-9(a)(2).
This appeal followed. Plaintiffs contend DMAHS cannot encumber the
property with a Medicaid lien because Philomene had a surviving spouse and
owned the property with him as tenants by the entirety. They also contend the
lien cannot be enforced because DMAHS did not timely file the lien and
enforcement of the lien would constitute an impermissible taking. Finally, they
argue the court erred in denying their counsel-fee application. Unpersuaded by
those arguments, we affirm.
A-1344-24
5
II.
Because the meaning of a statute is a question of law, we review a trial
court's statutory interpretation de novo. In re H.D., 241 N.J. 412, 418 (2020);
Manalapan Realty, L.P., v. Twp. of Comm. of Manalapan, 140 N.J. 366, 378
(1995). In performing that de novo review, we are guided by the well-
established principles of statutory construction. Those principles apply equally
to our interpretation of regulations. Medford Convalescent & Nursing Ctr. v.
Div. of Med. Assistance & Health Servs., 218 N.J. Super. 1, 5 (App. Div. 1985)
(finding "[r]egulations are subject to the same rules of construction as a
statute").
When interpreting a statute, we "determine and give effect to the
Legislature's intent." In re H.D., 241 N.J. at 418 (quoting N.J. Dep't of Child.
& Fams., Div. of Youth & Fam. Servs. v. A.L., 213 N.J. 1, 20 (2013)).
"[S]tatutory construction begins with an examination of the plain language of
the statute, 'ascrib[ing] to the . . . words their ordinary meaning and
significance.'" State v. Higginbotham, 257 N.J. 260, 280 (2024) (omission and
second alteration in original) (quoting DiProspero v. Penn, 183 N.J. 477, 492
(2005)). "We 'may neither rewrite a plainly-written enactment of the Legislature
nor presume that the Legislature intended something other than that expressed
A-1344-24
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by way of the plain language.'" Ibid. (quoting O'Connell v. State, 171 N.J. 484,
488 (2002)). To determine legislative intent, we "look not only at the particular
statutory language but also to the design of the statute as a whole." Est. of
DeMartino v. Div. of Med. Assistance & Health Servs., 373 N.J. Super. 210,
219 (App. Div. 2004).
Applying those rules, we consider the statutory scheme at issue. "The
federal Medicaid Act, under Title XIX of the Social Security Act, 42 U.S.C. [§§
1396 to 1396w-8], authorizes a joint federal-state program to provide assistance
to individuals whose income and resources are insufficient to meet the costs for
necessary medical services." D.C. v. Div. of Med. Assistance & Health Servs.,
464 N.J. Super. 343, 353-54 (App. Div. 2020). "Participation in the Medicaid
program is optional for states; however, 'once a State elects to participate, it
must comply with the requirements' of the federal Medicaid Act and federal
regulations adopted by the Secretary of Health and Human Services in order to
receive federal Medicaid funds." Id. at 354 (quoting Harris v. McRae, 448 U.S.
297, 301 (1980)).
"New Jersey's participation in the federal Medicaid program was
authorized by the enactment of the New Jersey Medical Assistance and Health
Services Act (MAHSA), N.J.S.A. 30:4D-1 to -19.5." Ibid. "Under its enabling
A-1344-24
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legislation, [the New Jersey Department of Human Services (DHS)] is
designated as 'the single State agency to administer the provisions of [the
Medicaid Act].'" Ibid. (quoting N.J.S.A. 30:4D-5). "[T]he Director of DHS has
the authority to promulgate rules, regulations, and administrative orders
necessary to administer the Medicaid program." Ibid. DMAHS is the agency
within DHS responsible for implementing the State Medicaid program. Ibid.
DMAHS "is required to manage the State's Medicaid program in a fiscally
responsible manner." Est. of Dizon by Finamore v. Dep't of Human Servs., 481
N.J. Super. 451, 459 (App. Div. 2025).
"To further expand available funding for Medicaid benefits, the 'federal
Medicaid law has required participating states to enact certain "estate" recovery
provisions as part of their medical assistance plans.'" Ibid. (quoting DeMartino,
373 N.J. Super. at 217). "In doing so, Congress intended to give states 'wide
latitude' in seeking estate recoveries." DeMartino, 373 N.J. Super. at 219
(quoting In re of Est. of Thompson, 586 N.W.2d 847, 851 (N.D. 1998)).
"Allowing states to recover from the estates of persons who previously received
assistance furthers the broad purpose of providing for the medical care of the
needy; the greater amount recovered by the state allows the state to have more
A-1344-24
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funds to provide future services." Ibid. (quoting Belshe v. Hope, 38 Cal. Rptr.
2d 917, 925 (Cal. Ct. App. 1995)).
The Legislature "enacted statutes to comply with the federal estate
recovery requirements" and the commissioner of DMAHS "adopted regulations
to comply with" those requirements. In re Est. of Brown, 448 N.J. Super. 252,
259 (App. Div. 2017). For Medicaid recipients, who, like Philomene, "became
deceased on or after April 1, 1995 for whom a Medicaid payment was made on
or after October 1, 1993," the Legislature authorized DMAHS to file a lien
against and seek recovery "from the estate of the deceased recipient for
[Medicaid] assistance correctly paid . . . on [the deceased recipient's] behalf for
all services received when he [or she] was [fifty-five] years of age or older."
N.J.S.A. 30:4D-7.2(a)(2); see also 42 U.S.C. § 1396p(b)(1)(B); N.J.A.C. 10:49-
14.1(d). As we held in Dizon, "[t]he plain meaning of the statute permits the
Division to seek reimbursement for all Medicaid benefits paid on a deceased
recipient's behalf by filing a lien against their estate." 481 N.J. Super. at 461.
"[T]o satisfy the federal estate recovery requirements, states must define
a decedent's estate to include at least 'all real and personal property and other
assets included within the individual's estate, as defined for purposes of State
probate law[.]'" In re Est. of Brown, 448 N.J. Super. at 258 (quoting 42 U.S.C.
A-1344-24
9
§ 1396p(b)(4)(A)). Federal law also authorizes states to broadly define the term
"estate" to include "any other real and personal property and other assets in
which the individual had any legal title or interest at the time of death . . .
including such assets conveyed to a survivor . . . of the deceased individual
through joint tenancy, tenancy in common, survivorship, . . . or other
arrangement." 42 U.S.C. § 1396p(b)(4)(B).
Under N.J.S.A. 30:4D-7.2(a)(3), an "estate" includes:
all real and personal property and other assets . . . as
defined in N.J.S.[A.] 3B:1-1, as well as any other real
and personal property and other assets in which the
recipient had any legal title or interest at the time of
death, to the extent of that interest, including assets
conveyed to a survivor, heir or assign of the recipient
through joint tenancy, tenancy in common,
survivorship, life estate, living trust or other
arrangement.
See also N.J.S.A. 3B:1-1 (defining estate as "all of the property of a decedent
. . . as the property is originally constituted and as it exists from time to time
during administration"). The corresponding regulation contains the same
definition of estate as set forth in N.J.S.A. 30:4D-7.2(a)(3). See N.J.A.C. 10:49-
14.l(l)(1) to (2). Thus, consistent with federal law, under New Jersey law, "[i]t
is clear an estate asset is widely defined to include all interests a Medicaid
recipient possessed at the time of death." Dizon, 481 N.J. Super. at 461. For
A-1344-24
10
Philomene that definition included the interest in the property she held at the
time of her death.
That she held her interest in the property as a tenancy by the entirety does
not render it an uncollectible asset under the Medicaid statutes. Although the
definitions of estate do not specifically reference tenancies by the entirety, the
breadth of the definitions clearly encompass them. See Est. of Marusich v. State,
ex rel., Dep't of Health, Off. of Healthcare Fin./Equalitycare, 313 P.3d 1272,
1278 (Wyo. 2013) (holding that property held by a tenancy by the entirety may
be encumbered by a Medicaid lien under the expanded definition of "estate"
Wyoming adopted pursuant to 42 U.S.C.A. § 1396p(b)(4)(A) to (B) even though
tenancies by the entirety were not specifically referenced). And consistent with
estate recovery requirements, the DMAHS commissioner adopted N.J.A.C.
10:49-14.1(m), a regulation that expressly authorizes liens on property held as
a tenancy by the entirety: "If the deceased Medicaid beneficiary held a tenancy-
by-the-entirety or joint tenancy with a right of survivorship, then the lien shall
state that it encumbers all of the property."
That Philomene was survived by her spouse does not impact DMAHS's
ability to place a lien on the property; it impacts the timing of its efforts to
enforce and recover based on the lien. Federal Medicaid law plainly states that
A-1344-24
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recovery "may be made only after the death of the individual's surviving
spouse." 42 U.S.C.A. § 1396p(b)(2). Thus, "[s]tates may recover Medicaid
benefits after the death of the recipient's surviving spouse . . . ." DeMartino,
373 N.J. Super. at 217 (citing 42 U.S.C.A. § 1396p(b)(2)).
New Jersey law is consistent with federal law. If a Medicaid beneficiary
dies and leaves no surviving spouse, DMAHS can recover benefit costs from the
deceased beneficiary's estate. N.J.A.C. 10:49-14.1(a)(1). However,
[e]ffective for estates pending on or created after
October 4, 1999, if a family member of a deceased
Medicaid beneficiary has, prior to the beneficiary's
death, continuously resided in a home owned by the
beneficiary at the time of the beneficiary's death, and
that home was the beneficiary's primary residence, and
was and remains the family member's primary
residence, the Division may record a lien against the
property, but will not enforce the lien until the property
is voluntarily sold, or the resident family member either
dies or vacates the property.
[N.J.A.C. 10:49-14.1(g).]
Plaintiffs focus on the language of N.J.A.C. 10:49-14.1(a)(1) but
disregard the language of N.J.A.C. 10:49-14.1(g). That we cannot do. See In
re Commitment of W.W., 245 N.J. 438, 449 (2021) ("[A] statute must 'be read
in [its] entirety; each part or section should be construed in connection with
every other part or section to provide a harmonious whole.'" (second alteration
A-1344-24
12
in original) (quoting In re D.J.B., 216 N.J. 433, 440 (2014))). Applying
plaintiffs' overly-narrow interpretation of N.J.A.C. 10:49-14.1(a)(1) would
render meaningless the language of N.J.A.C. 10:49-14.1(g) and 42 U.S.C.A. §
1396p(b)(2) and would be contrary to clear legislative intent behind the federal
and state Medicaid statutory schemes.
We are equally unconvinced by plaintiffs' argument the lien is
unenforceable because it was untimely. N.J.S.A. 30:4D-7.4 does not impose a
time limit for the filing of a lien. For estates created on or after October 4, 1999,
N.J.A.C. 10:49-14.1(d) provides: "the Division shall file any claim or lien
against an estate under this section within three years after receiving actual
written notice from the personal representative of the estate or any other
interested party of the death of the Medicaid beneficiary." The regulation sets
a timeframe for filing a claim or a lien but does not require DMAHS to file the
claim or lien in the Superior Court or docket or record the claim or lien.
Plaintiffs read that language into the regulation. We cannot do so. "To engraft
[language] to a statute . . . far exceeds the judiciary's role in such matters."
Simadiris v. Paterson Pub. Sch. Dist., 466 N.J. Super. 40, 49 (App. Div. 2021).
As the trial court found, DMAHS complied with the regulation when it
submitted its claim in 2012, as confirmed by DMAHS's estate recovery
A-1344-24
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information system and Henry's April 2019 letter. We have no basis to disturb
the trial court's legal conclusion and factual finding on that issue.
Plaintiffs contend on appeal that the lien infringed on Clerveaux's
constitutional property rights. Clerveaux did not challenge the lien during his
lifetime, and the trial court declined to consider the constitutional argument
plaintiffs' counsel attempted to make during argument, finding plaintiffs had not
previously raised it. We generally "decline to consider questions or issues not
properly presented to the trial court . . . unless the questions so raised on appeal
go to the jurisdiction of the trial court or concern matters of great public
interest." Nieder v. Royal Indem. Ins. Co., 62 N.J. 229, 234 (1973) (quoting
Reynolds Offset Co. v. Summer, 58 N.J. Super. 542, 548 (App. Div.1959)); see
also Alloco v. Ocean Beach & Bay Club, 456 N.J. Super. 124, 145 (App. Div.
2018) (applying "well-settled" principle that appellate court will not consider an
issue that was not raised before the trial court). But even considering it, we are
unpersuaded by plaintiffs' argument the lien is an unconstitutional taking.
"The New Jersey Constitution provides protections against governmental
takings of private property without just compensation, coextensive with the
Takings Clause of the Fifth Amendment of the United States Constitution."
Klumpp v. Borough of Avalon, 202 N.J. 390, 405 (2010).
A-1344-24
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A constitutional taking may occur in one of two ways:
1) via physical taking, in which the government takes
title to private property or "authorizes a physical
occupation [or appropriation] of property"; or 2) via
regulatory taking, through which a government
regulation deprives the property owner of all
economically viable use of their land.
[Ibid. (alteration in original) (quoting Yee v. City of
Escondido, 503 U.S. 519, 522 (1992)).]
"To accomplish a physical taking, the government may either enter the land
without authorization or exercise its power of eminent domain through a
condemnation proceeding." Id. at 405-06. DMAHS's lien is not an
unconstitutional "taking[] of private property without just compensation." Id. at
- It is an effort to obtain reimbursement of the cost of medical benefits
undisputedly paid on Philomene's behalf through her interest in the property.
Plaintiffs contend the property should be excluded from the reach of the
statutes at issue because Clerveaux and Philomene purchased it in 1986. Th at
argument is flawed because plaintiffs' proposed grandfathering provision is
nowhere in the statutes or regulations. Again, we cannot add language to a
statute, especially language that is inconsistent with the existing statutory
language. The Legislature expressly set forth the scope of DMAHS's authority
to impose a lien in N.J.S.A. 30:4D-7.2, limiting it based on the date the Medicaid
recipient died and received benefits, not based on the date the recipient
A-1344-24
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purchased the property to be encumbered. See N.J.S.A. 30:4D-7.2(a)(2). We
cannot "rewrite a plainly-written enactment of the Legislature." Higginbotham,
257 N.J. at 280 (quoting O'Connell, 171 N.J. at 488).
For all of those reasons, we affirm the December 10, 2024 judgment. We
affirm the December 5, 2024 order denying plaintiffs' counsel-fee application
for the reasons set forth in the trial court's attached statement of reasons .
Affirmed.
A-1344-24
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