Health care costs continue to rise, and shifting federal policies threaten long-standing access to coverage. New Jerseyans are calling on the state government to protect their health care. Federal cuts to Medicaid mean hundreds of thousands of residents are expected to lose coverage, and billions of dollars that once supported the state’s health care system are disappearing. A New Jersey bill recently signed into law, A5324, attempts to fill the budget gap by collecting a new fee from employers with 50 or more employees enrolled in Medicaid.
New federal laws passed through H.R. 1, also known as the “One Big Beautiful Bill Act,” cut funding and created harmful restrictions for Medicaid, the hospital system, and health insurance marketplaces. As a result, an estimated 300,000 New Jersey residents will likely lose their Medicaid coverage, nearly one-fifth of the 1.8 million residents covered as of June 2026. With these cuts, the Garden State stands to lose an estimated $3.3 billion in federal Medicaid funding. The resulting increases in the costs for uncompensated care for uninsured residents and loss of Medicaid payments for providers put facilities that operate in rural areas and safety net hospitals for lower-income communities in urban areas at greater risk of closure, worsening racial and socio-economic health disparities.
Under the new law, New Jersey employers with 50 or more employees enrolled in Medicaid would face an annual per-employee fee. The number of employees enrolled in Medicaid determines an employer’s fee tier. The state then charges that tier’s rate for every employee and every dependent enrolled.
The law includes a variety of exemptions that will lower the generated revenue and create budget uncertainty in the coming years. Beginning with the first year, the state will not collect a fee for employees or dependents with a developmental, intellectual, or permanent physical disability. Beginning on July 1, 2027, the fee will also exclude part-time, per diem, or temporary employees; seasonal employees; and employees who have been employed for less than 90 days at the time the fee is determined. Employers who pay the fee for these employees prior to that date will be able to file for a credit or refund starting in 2028. These exceptions and changing business tax calculations mean that the estimated funds that the state will collect swing from $154.1 million in the first year down to $23.2 million in the second year. It is unclear where the funding will stabilize in later years.
The fee focuses only on residents already enrolled in Medicaid. It does nothing to expand coverage options for uninsured employees or make health care more affordable for residents. Most federal dollars lost from the H.R. 1 cuts come from the expected lower enrollment and loss of matching funds. A fee that does not aim to keep people enrolled in Medicaid will not stop that loss.
Finally, the fee as currently designed could harm workers and their families. The state’s framing of Medicaid enrollment as a burden creates a stigma for low-income workers for whom Medicaid may be the best coverage option for them and their families. The fee exemptions mean an employer could reduce hours or jobs for full-time employees and favor part-time employees who do not qualify for benefits or count toward the fee. Calculating the fee may require unnecessary collection of sensitive information, including the immigration status of temporary and seasonal workers. This conflicts with the state’s investment in programs like Cover All Kids.
A strong state budget relies on a stable health care system. Achieving that stability requires the state to prioritize affordable coverage options. Other states, including Massachusetts have, at times, tried different types of fees based on program enrollment to cover rising costs. These fees have not remained in place. Instead, broader tax and support approaches have proven to be more predictable and sustainable. As federal cuts loom, New Jersey leaders need to act. They must stabilize revenue, keep people enrolled in Medicaid, and create new coverage options that address growing barriers to care.

