Topic Category: Health

Who Pays for a Per-Employee Medicaid Fee?

Posted on by Peter Chen

A fee tied to individual employees’ health coverage will encourage employers to find loopholes and harm workers.

That’s the core problem with Governor Mikie Sherrill’s proposal to charge large employers based on how many of their workers are enrolled in NJ FamilyCare, the state’s Medicaid program. In her first state budget address, Gov. Sherrill proposed collecting fees from employers who have 50 or more workers with Medicaid coverage. The fee would reportedly charge $325 to $725 per employee, depending on the number of employees.

In the wake of deep federal cuts to Medicaid, states — including New Jersey — are scrambling to protect their investments in affordable health care. Those revenue-raising proposals should focus on ensuring that wealthy individuals and corporations pay for health care, while protecting residents enrolled in Medicaid.

Support for Health Care Programs Must Avoid Punishing Covered Workers

While an assessment on employers to pay for employees’ Medicaid coverage might sound like an attractive way to tax big businesses to support health care, the problems with a fee structured as a charge per employee raise serious concerns. A fee designed around individual employees’ coverage in NJ FamilyCare could:

  • Discourage employers from hiring workers who have or might enroll in NJ FamilyCare. Workers who need health coverage most would face the greatest barriers to employment. Employers could screen out job applicants they perceive as likely to need Medicaid, creating discrimination against workers from low-income backgrounds.
  • Cause workers and their families to hesitate to enroll in NJ FamilyCare, even when they are eligible. Similar to immigrant residents’ fears about public charge rules — rules that can deny visas and green cards based on expected enrollment in certain government programs — this unfairly puts the burden on residents to take unnecessary risks in order to avoid even the potential of punishment.
  • Create and worsen stigma around NJ FamilyCare and other state-run health care programs. This could push residents toward employer-based health coverage, despite its drawbacks like its varying quality and inability to transfer with job changes. This concern affects workers in low-wage jobs and temporary positions most.

 
This fee structure treats workers with NJ FamilyCare as a problem to solve rather than residents seeking quality coverage. It pressures workers to accept potentially lower-quality coverage options through their employer. Workers might also feel stuck, tied to any job they have coverage for, even if they are enduring poor working conditions and are eligible for Medicaid. Ultimately, the fee does nothing to expand coverage options to help the 727,000 uninsured New Jerseyans, nor does it improve the affordability of coverage for workers.

Existing State Tools Can Build Broad-Based Support for NJ FamilyCare

At a time when costs are rising and families across the state are struggling with affordability, state leaders should focus on ensuring corporations and wealthy residents are paying their fair share for public goods. This includes building broader, more sustainable funding support for NJ FamilyCare and expanding coverage options for all residents. Long-term support for residents’ health care would eliminate funding loopholes and make it easier, rather than more difficult, for New Jerseyans to enroll in coverage and remain covered, even when life circumstances change.

New Jersey already has the tools to more sustainably fund NJ FamilyCare in the long term. Using these tools to build a broader base of support for programs would be more efficient and effective in ensuring long-term fiscal stability. In particular, policymakers should increase revenue from the Corporation Business Tax by closing loopholes, eliminate unnecessary tax credits for big businesses, and discourage and punish tax avoidance strategies. These efforts could raise similar amounts of revenue to fund Medicaid and improve the state’s fiscal stability through an uncertain future.

Federal Cuts Threaten Health Coverage for 727,000 New Jerseyans

Posted on by NJPP Staff

More than 727,000 New Jerseyans currently lack health insurance, and that number will grow dramatically as Congress eliminates $500 million in marketplace subsidies and imposes new Medicaid work requirements, according to a new report from New Jersey Policy Perspective.

Most uninsured New Jerseyans work jobs considered “essential” during COVID — retail cashiers, farm workers, construction workers — but their employers don’t provide health coverage. Immigrant residents are nearly 9 times more likely to be uninsured than native-born citizens.

“We have proof that policy solutions work,” said Brittany Holom-Trundy, Research Director at New Jersey Policy Perspective and author of the report. “The ACA brought coverage to 515,000 more New Jerseyans since 2014. GetCovered NJ enrollment more than tripled. Medicaid expansion covered nearly 390,000 people who fell through the cracks. Federal cuts now threaten to reverse all this progress.”

Key findings:

  • Enhanced federal subsidies expired, eliminating $500 million that helped New Jersey residents afford marketplace coverage through GetCovered NJ
  • New Medicaid work requirements starting in 2027 will kick eligible people off coverage through paperwork barriers. Evidence from Arkansas shows these requirements don’t increase employment
  • Federal lawmakers are eliminating coverage options for immigrants, who already face the highest barriers to affordable insurance
  • The ACA worked: 515,000 more New Jerseyans gained coverage since 2014. GetCovered NJ enrollment tripled to 513,217

 

The report calls on state leaders to expand subsidies, fix enrollment systems, create a public option, and ensure equal access across counties.

“Congress is abandoning working families who were on the front lines during the pandemic,” said Holom-Trundy. “State leaders have the tools to counter these federal cuts. The question now is whether they’ll act before families are pushed into crisis.”

Read the full report at NJPP.org

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Mind the Gap: Keeping New Jerseyans Covered in the Face of Federal Cuts

Posted on by Brittany Holom-Trundy

More than 727,000 New Jerseyans — roughly 1 in 13 residents — face daily life without health insurance.[1] That number is about to grow dramatically.

Congress is stripping coverage from hundreds of thousands more residents by eliminating subsidies, imposing new Medicaid work requirements, and creating unnecessary paperwork barriers.[2] These actions will reverse a decade of progress in expanding health coverage and leave working families without access to medical care.

Health insurance is not optional for a thriving New Jersey. Coverage reduces debt, improves health outcomes, and allows families to plan for their futures.[3] It improves public health through preventive care and reduces costs for hospitals and the state.[4] Yet continued gaps in coverage options and rising costs keep quality health coverage out of reach for many working families.

Without immediate state action to counter federal cuts, hundreds of thousands more New Jerseyans will lose coverage. State leaders must act now to protect residents by providing increased financial assistance, expanding coverage options, and standardizing outreach across counties.

Congress Is Stripping Coverage Through Four Major Actions

 Through the recently enacted "One Big Beautiful Bill Act" (H.R. 1), federal lawmakers are dismantling health coverage supports with actions that will devastate New Jersey families. These actions will strip coverage from working people, increase medical debt, and push families into crisis, directly contradicting the hard-won lessons of the COVID-19 pandemic about the importance of accessible, affordable health care.[5]

Enhanced subsidies have expired. Congress allowed enhanced federal subsidies on health insurance marketplaces to expire, pulling $500 million in assistance out of New Jersey residents alone.[6] Without these subsidies, many working families will no longer be able to afford marketplace plans through GetCovered NJ.

New work requirements will kick eligible people off coverage. Starting in 2027, federal law will require adult Medicaid enrollees ages 19 to 64 to complete 80 hours of work or community service each month — or lose coverage.[7] Evidence from Arkansas shows that work requirements don’t increase employment, they cause mass coverage losses because people cannot navigate complex reporting systems. New Jersey families will lose coverage not because they are ineligible, but because paperwork barriers block access to care.[8]

Increased paperwork requirements create barriers to coverage. Adults enrolled through Medicaid expansion must now submit paperwork proving they still qualify every six months instead of once a year.[9] This will cause eligible people to lose coverage simply because they miss paperwork deadlines. Recent coverage losses when pandemic protections ended revealed that thousands of New Jerseyans lost coverage not because they were ineligible but because they could not navigate the system.[10]

Immigrant coverage is being eliminated. Federal lawmakers are eliminating affordable coverage options that immigrants previously relied on through provisions of H.R. 1, the “One Big Beautiful Bill Act.”[11] This will increase the already severe barriers that immigrant residents face in accessing health coverage.

Impact on New Jersey

 These federal actions threaten to:

  • Strip coverage from hundreds of thousands of residents
  • Eliminate $500 million in marketplace subsidies
  • Create paperwork barriers that will cause massive coverage losses among eligible Medicaid enrollees
  • Further increase the uninsured rate among immigrant communities already facing the highest barriers

 

With federal support disappearing, state leaders must stabilize access and protect residents and their futures.

Working Families and Immigrants Face the Highest Barriers

Gaps in the health care system leave hundreds of thousands of New Jerseyans without coverage. Eligibility limits, bureaucratic barriers, and lack of information about programs prevent many residents from enrolling in coverage they need and can afford.[12]

Most Uninsured New Jerseyans Work — But Employers Don't Provide Coverage

Most uninsured New Jerseyans have jobs but their employers do not provide health coverage. They work as retail cashiers, farm workers, construction workers, and social service workers; the same jobs considered "essential" during the COVID-19 pandemic.[13]

Immigrants and residents working low-wage, temporary, or seasonal jobs struggle the most to enroll in coverage.[14] These barriers perpetuate racial and income inequities in coverage, reflecting the ongoing effects of historical racism, xenophobia, and discrimination.[15]

Racial Inequities Persist Due to Historical Racism

Because of historical racism, Black and Latinx/Hispanic residents are more likely to work in industries and jobs that do not provide coverage.[16] This worsens racial inequities in coverage.[17] The jobs most likely to lack coverage are also the jobs that Black and Latinx/Hispanic workers are disproportionately employed in due to discriminatory hiring practices and occupational segregation.

Immigrants Face the Highest Barriers to Coverage

Immigrants face the highest barriers to coverage of any group. They qualify for fewer programs than citizens, and the programs they can access offer less financial help.

New Jerseyans who are not citizens are nearly nine times more likely to be uninsured than native-born citizens and nearly five times more likely to be uninsured than naturalized citizens.[18]

Immigrants are overrepresented among the uninsured because they have so few affordable coverage options, especially those living on low incomes. Even in counties with strong outreach and low uninsured rates overall, immigrants remain ineligible for programs or face significant obstacles to purchasing affordable coverage.

Without affordable coverage options, immigrant residents who cannot pay expensive premiums on their own are left uninsured. Strong outreach efforts are critical to connecting eligible immigrants with coverage by addressing language barriers, providing information, and building trust.[19] This is especially important when federal policies threaten immigrant communities more broadly.[20]

With Federal Policy Changes, Health Coverage Options for Immigrants are Disappearing

Working-Age Adults Are Most Affected

Working-age adults face the highest barriers to coverage. Four out of every five uninsured residents across all counties are working-age adults. Seniors make up the smallest proportion of uninsured residents.[21] Medicare coverage ensures they are the least likely to struggle with access.[22]

While these coverage gaps reflect national problems, state leaders can address them by protecting residents through policy action.

The ACA Proves State Action Can Expand Coverage 

The Affordable Care Act transformed health coverage in New Jersey. Since 2014, when the law's major provisions took effect, 515,000 more residents gained insurance — coverage that protects their health and financial security.[23]

Two provisions drove this progress: the creation of GetCovered NJ, the state health insurance marketplace, and the expansion of Medicaid to cover more adults with low incomes.

Improvements in Affordable Coverage Options Have Reduced the Number of Uninsured New Jerseyans

GetCovered NJ Enrollment Has More Than Tripled

GetCovered NJ serves residents who cannot get affordable insurance through their jobs and do not qualify for Medicaid. The marketplace allows them to purchase coverage with financial help from the state and federal government.[24]

Since 2014, enrollment has more than tripled — from 161,775 in the first year to 513,217 in 2025.[25] The marketplace now provides essential coverage to more than 350,000 additional New Jerseyans.[26]

Fast Facts: New Jersey’s Uninsured Residents

3 of every 4 uninsured residents who are working-age are employed at least part-time.Residents with incomes below 100% of the federal poverty level are nearly 5 times more likely to be uninsured than those with higher incomes.

1 of every 3 uninsured residents work in industries with more low-wage and temporary jobs, such as construction or arts, entertainment, accommodation, or food services.

1 of every 9 uninsured residents work in the essential services of education, health care, and social assistance.

Hispanic/Latinx residents are 6 times more likely to be uninsured than non-Hispanic/Latinx white residents.

Black residents are over twice as likely to be uninsured as non-Hispanic/Latinx white residents.

Source: NJPP Analysis of U.S. Census Bureau, American Community Survey  - 2024 5-Year Estimates, Tables S2701 and S2702.

Medicaid Expansion Closed the Coverage Gap

Medicaid expansion brought coverage to nearly 390,000 New Jerseyans who previously fell through the cracks.[27] These residents — adults with incomes up to 138 percent of the federal poverty level ($22,025 per year for a single adult in 2026) — earn too much to qualify for traditional Medicaid but too little to afford coverage on their own, especially with limited financial help.[28]

Their jobs do not offer health insurance, and their paychecks leave little room for premiums. Medicaid expansion closed this gap, providing quality coverage to residents working hard to get by. 

Progress Is Now Threatened by Federal Cuts

Despite these improvements, residents living on low incomes and immigrants continue to face barriers to affordable health insurance. Now, federal lawmakers are withdrawing support from programs that serve families with the fewest resources, threatening to leave even more people without coverage.[29]

The ACA’s success shows that policy solutions work when properly funded and implemented. State leaders must build on this progress by countering federal cuts with state action.

State Leaders Must Counter Federal Cuts

New Jersey leaders must continue to adequately fund existing programs like Cover All Kids and take these additional actions to protect residents from federal cuts:

Expand State Subsidies on the GetCovered NJ Marketplace

The elimination of the protections provided during the COVID-19 pandemic — including enhanced premium tax credits on the health insurance marketplaces and fewer administrative barriers for continuous coverage — has set health coverage back in direct contradiction to the lessons learned during that crisis.[30]

By expanding state subsidies — the New Jersey Health Plan Savings — already provided through GetCovered NJ, the gaps created by federal cuts can be filled with a reliable funding source, ensuring that residents can continue to afford plans through the marketplace.[31] In recent years, the state spent $215 million in funds raised through a state assessment paid by health insurance companies on these subsidies to help lower the cost of plans for residents. Dedicating more state funds toward these subsidies can help to fill some of the gap left by the expected loss of $500 million in federal assistance.[32]

Improve Data Sharing and Enrollment Systems to Prevent Paperwork-Driven Coverage Loss

Beginning in 2027, adult Medicaid enrollees aged 19 to 64 will be required to complete 80 hours of “community engagement,” defined as qualifying work or community service unless enrolled in certain educational programs. If they do not meet the requirement and do not qualify for an exemption, they will lose coverage.[33] Additionally, many of those same enrollees — those adults enrolled through the ACA Medicaid expansion — will now be required to submit redetermination paperwork every 6 months, rather than once a year.[34]  Both of these requirements increase the likelihood that people will lose coverage simply due to administrative barriers.[35]

The state must take immediate action to invest in cross-departmental data sharing to reduce the paperwork required  of residents with low incomes to receive all of the support for which they are eligible. Additionally, improving the accessibility of programs dealing with enrollment and reporting in order to ensure that the paperwork is as easy to understand, fill out, and submit as possible will help to reduce the number of people who struggle to complete the requirements.[36] The recent massive coverage losses during the Medicaid unwinding — when the state had to reevaluate all Medicaid enrollees’ eligibility as pandemic protections were removed — emphasized the communication gaps and paperwork system barriers that residents face to maintain coverage.[37] Improvements to these systems are critical for protecting New Jerseyans.[38]

Establish a State Government-Backed Insurance Plan to Close Coverage Gaps

When people cannot afford health insurance, they go without coverage to pay rent, keep the lights on, and put food on the table.[39] Without immediate health concerns, these needs feel more urgent. No one should face this choice, yet it is the reality for many New Jerseyans because gaps in coverage options define the state's health care system.

Currently, every affordable coverage option in the state, except NJ FamilyCare for children, limits eligibility based on immigration status or other factors. Many people cannot even buy into Medicaid, CHIP, or marketplace coverage by paying a reasonable premium — they are simply shut out.

State leaders should establish a government-backed health insurance plan — a “public option” — open to all residents regardless of age or immigration status. This would provide affordable coverage to residents who have limited or no options in the current system. A well-designed public option can also reduce costs system-wide and improve affordability for everyone.[40]

Ensure Equal Access to Enrollment Across Counties

County social services boards help residents enroll in coverage, but their staffing and outreach vary widely.[41] In counties where leaders refuse to commit resources, fewer eligible residents get enrolled.

The state should strengthen oversight of county boards and require better pay and benefits to attract qualified staff. These steps would reduce gaps between counties and help more New Jerseyans get covered.

Adequate staffing allows county workers to conduct targeted outreach to communities that face the highest barriers to enrollment, including immigrant communities that need language assistance and trust-building efforts.[42] This is especially true when exclusionary policies threaten immigrant communities more broadly.[43] When counties lack resources, these critical outreach efforts simply do not happen.

Conclusion

New Jersey has made remarkable progress expanding health coverage over the past decade. The Affordable Care Act brought insurance to more than half a million residents who previously went without. GetCovered NJ and Medicaid expansion closed critical gaps in the system.

Federal cuts now threaten to reverse this progress. Enhanced subsidies have expired, new work requirements will create paperwork barriers, and immigrants are losing access to affordable options. Without state action, thousands more New Jerseyans will lose coverage.

State leaders have the power to protect residents and their families. By increasing state subsidies, fixing broken enrollment systems, creating a public option, and ensuring equal county access to enrollment support, New Jersey can counter federal cuts and continue expanding coverage to those who need it most.

The choice is clear: act now to protect New Jerseyans, or watch a decade of progress disappear.

The stakes are clear. Will state leaders act to protect residents, or will they allow federal cuts to strip coverage from hundreds of thousands of working families?

End Notes

[1] U.S. Census Bureau, American Community Survey -- 2024 1-Year Estimates, Table S2701, 2025. The 1-year estimate, rather than the 5-year estimate, is provided here to give the most current picture of the number of uninsured in light of the significant changes that have happened through the Medicaid unwinding and other point-in-time effects.

[2] For a full timeline of the federal cuts affecting New Jersey, see: Ambrose, A., Chen, P., Holom-Trundy, B., and Ubel, M., State Lawmakers Should Protect Residents from Federal Cuts to Vital Services, New Jersey Policy Perspective, Aug. 2025.

[3] McGough, M., State-Based Efforts Will Provide Limited Relief from Enhanced Tax Credit Expiration, KFF, Jan. 2026. New Jersey Department of Banking and Insurance, Impact of Proposed Congressional Reconciliation Bill Package on New Jersey Residents Enrolled in Health Coverage Through Get Covered New Jersey, Jun. 2025.

[4] New Jersey Department of Human Services, Statement from Human Services Commissioner Sarah Adelman, Jul. 2025.

[5] Holom-Trundy, B., Beyond the Pandemic: New Data Reveals Growing Health Insurance Coverage Gaps, New Jersey Policy Perspective, Sep. 2024. Buettgens, M., et al., 4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire, Urban Institute, Sep. 2025. Lo, J., et al., ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire, KFF, Sep. 2025.

[6] McGough, M., State-Based Efforts Will Provide Limited Relief from Enhanced Tax Credit Expiration, KFF, Jan. 2026.; New Jersey Department of Banking and Insurance, DOBI Response to OLS Questions on FY 2026 Budget, Jun. 2025. Biryukov, N., Rates on NJ health insurance marketplace to skyrocket, state regulator warns, New Jersey Monitor, Oct. 2025.

[7] Centers for Medicare & Medicaid Services, Bulletin on Section 71119 of the “Working Families Tax Cut” Legislation, Public Law 119-21: Requirements for States to Establish Medicaid Community Engagement Requirements for Certain Individuals, Dec. 2025.

[8] Sommers, B.D., Goldman, A.L., Blendon, R.J., Orav, J., and Epstein, A.M., Medicaid Work Requirements — Results from the First Year in Arkansas, The New England Journal of Medicine, v. 381, no. 11, Jun. 2019. Medicaid and CHIP Payment and Access Commission (MACPAC), An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP, Oct. 2021.

[9] KFF, Health Provisions in the 2025 Federal Budget Reconciliation Bill, Jul. 2025.

[10] New Jersey Department of Human Services, Stay Covered NJ Renewal Data, Jun. 2024.

[11] Stainton, L., Thousands of legal immigrants in NJ could be thrown off Medicaid, NJ Spotlight News, Jul. 2025.

[12] For eligibility limitations, see the NJ FamilyCare website: New Jersey Department of Human Services, NJ FamilyCare - Who is Eligible? and NJ Familycare - Immigrant Information, 2025. For the estimate of the loss due to recent federal changes, see: New Jersey Department of Human Services, Statement from Human Services Commissioner Sarah Adelman on Impact of Medicaid and SNAP Cuts on NJ, Jul. 2025. Imperato, N. and Doobay, K., Evaluating the Policy Implications and Impact of Health Insurance Literacy Initiatives, New Jersey State Policy Lab, Rutgers University, 2025.

[13] National Conference of State Legislatures, COVID-19: Essential Workers in the States, Jan. 2021.

[14] NJPP Analysis of U.S. Census Bureau, American Community Survey – 2024 5-Year Estimates, Tables S2701 and S2702, 2025.

[15] Holom-Trundy, B., Unprecedented and Unequal: Racial Inequities in the COVID-19 Pandemic, New Jersey Policy Perspective, Oct. 2020. Ndugga, N., Pillai, D., Hill, L., & Artiga, S., Race, Inequality, and Health, In Altman, Drew (Editor), Health Policy 101, KFF, Oct. 2025. Philbin, M., et al. State-Level Immigration and Immigrant-Focused Policies as Drivers of Latino Health Disparities in the United States, Social Science & Medicine, v. 199, pp. 29-38, 2018.

[16] Yearby, R., Clark, B., and Figueroa, J.F., Structural Racism in Historical and Modern US Health Care Policy, Health Affairs, Feb. 2022.

[17] Holom-Trundy, B., Unprecedented and Unequal: Racial Inequities in the COVID-19 Pandemic, New Jersey Policy Perspective, Oct. 2020.

[18] NJPP Analysis of U.S. Census Bureau, American Community Survey -- 2024 5-Year Estimates, Table S2701, 2025.

[19] Clemente, I., and Casau, A., Covering All Kids: Strategies to Connect Children of Undocumented Status to Health Care Coverage, Center for Health Care Strategies, Feb. 2023.

[20] Novak, N.L., Kline, N., LeBrón, A.M.W., Lopez, W., Michelen, M., De Trinidad Young, M-E., Mitigating The Health Impacts Of Exclusionary Immigration Policies: An Evidence Review, Health Affairs Health Policy Brief, Nov. 2025.

[21] NJPP Analysis of U.S. Census Bureau, American Community Survey -- 2024 5-Year Estimates, Table 2701, 2025.

[22] Telesford, I., Winger, A., and Rae, M., Beyond Cost, What Barriers to Health Care do Consumers Face?, Peterson-KFF Health System Tracker, Aug. 2024.

[23] NJPP Analysis of U.S. Census Bureau, American Community Survey – 2010-2024 1-Year Estimates, Table S2701, 2025. The 1-year estimates were used for this comparison because the purpose was to compare two single points in time rather than an overall trend.

[24] New Jersey Department of Banking and Insurance, GetCovered NJ, 2025.

[25] KFF, Marketplace Enrollment, 2014-2025, 2025. Note that "marketplace" here refers to New Jersey's enrollment through the federally-run marketplace on HealthCare.Gov from 2014-2020 and then to the state-based marketplace, GetCovered NJ, from 2021 to today. New Jersey passed legislation in 2019 to create the state-based marketplace. See Office of Governor Phil Murphy, Governor Murphy Announces Launch of New State-Based Health Insurance Marketplace, Get Covered New Jersey, Oct. 2020. Holom-Trundy, B., GetCoveredNJ: How New Jersey’s State-Based Exchange Will Make Health Coverage More Affordable, New Jersey Policy Perspective, Nov. 2020.

[26] NJPP Analysis of KFF, Marketplace Enrollment, 2014-2025, 2025.The 2026 enrollment period is currently underway at the time of writing; it is on track to have enrollment numbers even higher than 2025. However, more enrollees are choosing lower level plans due to cost. See GetCovered NJ’s 2026 Open Enrollment Update, Week 9 Snapshot.

[27] NJPP Analysis of New Jersey Office of Management and Budget, Governor's FY 2026 Budget, Detailed Budget, p. D-209, Mar. 2025. Note that only the category "Expansion Childless Adults" is included here because some parents were covered through NJ FamilyCare prior to the Affordable Care Act's Medicaid expansion.

[28] N.J.A.C. 10:74-1.4, see definition of "NJ FamilyCare Alternative Benefit Plan (ABP)." U.S. Department of Health and Human Services, 2026 Poverty Guidelines: 48 Contiguous States (all states except Alaska and Hawaii), 2026.

[29] KFF, Health Provisions in the 2025 Federal Budget Reconciliation Law, Aug. 2025. Ambrose, A., Chen, P., Holom-Trundy, B., and Ubel, M., State Lawmakers Should Protect Residents from Federal Cuts to Vital Services, New Jersey Policy Perspective, Aug. 2025.

[30] Holom-Trundy, B., Beyond the Pandemic: New Data Reveals Growing Health Insurance Coverage Gaps, New Jersey Policy Perspective, Sep. 2024. Buettgens, M., et al., 4.8 Million People Will Lose Coverage in 2026 If Enhanced Premium Tax Credits Expire, Urban Institute, Sep. 2025. Lo, J., et al., ACA Marketplace Premium Payments Would More than Double on Average Next Year if Enhanced Premium Tax Credits Expire, KFF, Sep. 2025.

[31] New Jersey Department of Banking and Insurance, Lower Your Monthly Premiums with the NJ Health Plan Savings, GetCovered NJ, 2025.

[32] New Jersey Department of Banking and Insurance, DOBI Response to OLS Questions on FY 2026 Budget, Jun. 2025. Biryukov, N., Rates on NJ health insurance marketplace to skyrocket, state regulator warns, New Jersey Monitor, Oct. 2025.

[33] Centers for Medicare & Medicaid Services, Bulletin on Section 71119 of the “Working Families Tax Cut” Legislation, Public Law 119-21: Requirements for States to Establish Medicaid Community Engagement Requirements for Certain Individuals, Dec. 2025.

[34] KFF, Health Provisions in the 2025 Federal Budget Reconciliation Bill, Jul. 2025.

[35] Sommers, B.D., Goldman, A.L., Blendon, R.J., Orav, J., and Epstein, A.M., Medicaid Work Requirements — Results from the First Year in Arkansas, The New England Journal of Medicine, v. 381, no. 11, Jun. 2019. Medicaid and CHIP Payment and Access Commission (MACPAC), An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP, Oct. 2021.

[36] Wagner, J., Singleton, S., and Stewart, M., A Guide to Reducing Coverage Losses Through Effective Implementation of Medicaid’s New Work Requirement, Center on Budget and Policy Priorities, Nov. 2025. Diana, A., et al., Challenges with Implementing Work Requirements: Findings from a Survey of State Medicaid Programs, KFF, Oct. 2025.

[37] New Jersey Department of Human Services, Stay Covered NJ Renewal Data, Jun. 2024.

[38] New Jersey Department of Human Services, Meeting of the Medical Assistance Advisory Council - January 2026 Presentation, Jan. 2026.

[39] While the approach to bills differ across individuals and families and their needs, people who are struggling to pay bills each month are more likely to say that they are worried about paying utilities, food, and rent than they are about paying for health coverage. As ability to pay for bills increases, the health care costs become the focus, demonstrating a shift in priorities and needs: Montero, A., Kearney, A., Valdes, I., Kirzinger, A., and Hamel, L., KFF Health Tracking Poll: Economic Views and Experiences of Adults Who Struggle Financially, KFF, Feb. 2024. Additionally, those who are uninsured are more likely to report challenges affording health care costs: Sparks, G., Lopes, L, Montero, A., Presiado, M., and Hamel, L., Americans’ Challenges with Health Care Costs, KFF, Dec. 2025. Most people who are uninsured report that they do not have coverage due to the high cost: See Figure 7 in Tolbert, J., Bell, C., Cervantes, S. and Singh, R., The Uninsured Population and Health Coverage. In Altman, D. (Editor), Health Policy 101, KFF, Oct. 2025.

[40] Monahan, C.H., Stovicek, N., and Giovannelli, J., State Public Option Plans Are Making Progress on Reducing Consumer Costs, To the Point (blog), The Commonwealth Fund, Nov. 2023. King, J. S., Gudiksen, K.L., and Brown, E.C., Are State Public Option Health Plans Worth It?, Harvard Journal on Legislation, v. 59, pp. 145-219, 2022.

[41] Holom-Trundy, B., Understaffed and Underfunded: Barriers to Effective Anti-Poverty Assistance, New Jersey Policy Perspective, Nov. 2024.

[42] Clemente, I., and Casau, A., Covering All Kids: Strategies to Connect Children of Undocumented Status to Health Care Coverage, Center for Health Care Strategies, Feb. 2023.

[43] Novak, N.L., Kline, N., LeBrón, A.M.W., Lopez, W., Michelen, M., De Trinidad Young, M-E., Mitigating The Health Impacts Of Exclusionary Immigration Policies: An Evidence Review, Health Affairs Health Policy Brief, Nov. 2025.

Rising Uninsured Rates Demand Urgent State Action on Health Coverage

Posted on by Brittany Holom-Trundy

The number of New Jerseyans without health coverage has drastically increased as pandemic-era protections have wound down and new barriers to coverage have been constructed. Data released today from the 2024 American Community Survey reveals access to health insurance has gotten harder for the people who need it the most. In response, NJPP releases the following statement:

Brittany Holom-Trundy, Research Director, NJPP:

“Health insurance coverage gaps widened significantly in 2024, with uninsured rates rising from 7.2% to 7.7% according to today’s 2024 American Community Survey health insurance data. This confirms our concerns: As the pandemic’s lessons about access to affordable coverage have been left behind, barriers to health insurance have grown worse, especially for those with the lowest incomes.

“Most alarming, the end of Medicaid protections especially harmed families living in poverty, leaving them without coverage or access to care. Low-income households saw their uninsured rates jump from 13.8% to 17.7%.

“While New Jersey has taken important steps to improve access, such as the Cover All Kids program, these efforts have not addressed all gaps in the system. Combined with the coming federal Medicaid cuts, this data shows that the state urgently needs to expand coverage programs and ensure that all residents (regardless of age, race, gender, immigration status, disability, or employment status) have access to affordable coverage.”

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Federal Leaders Should Protect Access to Critical Health Programs

Posted on by Brittany Holom-Trundy

The Honorable Robert F. Kennedy Jr.
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

RE: (Docket ID Docket: AHRQ-2025-0002) Opposition to Personal Responsibility and Work Opportunity Reconciliation Act; Interpretation of ”Federal Public Benefit”

Dear Secretary Kennedy,

New Jersey Policy Perspective (NJPP) is a nonpartisan think tank that drives policy change to advance economic, social, and racial justice through evidence-based, independent research, analysis, and strategic communications. For decades, NJPP has provided timely and insightful research to policymakers in New Jersey to improve outcomes and opportunities for families and individuals across the state.

NJPP strongly opposes any attempt to restrict access to Health and Human Services programs that help build healthy communities. All the programs now being considered “federal public benefits” under this rule proposal would harm the health of those individuals excluded and all residents of the state.

Federally Qualified Health Centers (FQHCs)

Federally qualified health centers provide critical health care to communities often underserved by the health care system as a whole. More than 1 in 4 FQHC patients are uninsured, substantially higher than the state average.[i] In 2023, the state’s 138 FQHCs served more than 570,000 patients, including 145,700 uninsured patients.

People get sick and require care regardless of immigration status. Pushing those people out of the health care system by treating them as a “public charge” does not make them healthier or reduce usage of public benefits. Instead, these punitive policies hurt overall health and well-being by pushing families with mixed immigration status away from care.[ii]

These restrictions ignore an important fact: the FQHCs provide a service for the general welfare. This policy ignores the role that better health, nutrition and education have on society as a whole. If one group of people is excluded from or avoided basic medical care, healthy pregnancy and infancy, or early childhood experiences, those costs multiply on everyone.

Also, immigrants have higher employment rates than native-born adults, contributing greatly to the state and local economy. In New Jersey, immigrants are a major driver of business growth. The roughly 2.2 million immigrants living in the state generate billions in economic activity and local and state tax revenue.[iii] Excluding large parts of this population from basic care will hurt their ability to remain economically independent. This aligns with research showing that the cost of insuring immigrant residents is generally lower than the cost of insuring native-born residents.[iv]

Other programs

Similar logic applies to the vast array of programs now being considered “federal public benefits” under this proposal. Almost all of these programs provide benefits to the community when they reach a broad population:

  • Head Start programs and high-quality early childhood education reduce lifetime costs for child participants and improve a wide range of health and academic outcomes.
  • Substance Use Prevention, Treatment, and Recovery Services help reduce the risks of overdose and substance use disorder on families and communities.
  • Title X Family Planning helps families plan how many children to have and keep a family size they can support economically.
  • Community Services Block Grants provide funding to Community Action Agencies to deliver services that reduce poverty and promote independence.
  • Education and Training Voucher programs support youth aging out of foster care in pursuing higher education and developing independent living skills.
  • Kinship Guardianship Assistance Program ensures relatives who take guardianship of youth receive the guidance and resources needed to strengthen families, increase kinship placements, and promote long-term cost savings.

 

Simply put, these programs do not act as “benefits” to the recipients. Instead, these programs seek to reduce the overall cost to society and government by providing preventative measures that encourage economic independence and security.

NJPP urges HHS to withdraw this proposed rule that misclassifies these prevention measures that benefit all residents as “federal public benefits” that go to a select few.

Sincerely,

Brittany Holom-Trundy
Research Director
New Jersey Policy Perspective

End Notes

[i] New Jersey Primary Care Association, Federally Qualified Health Centers in New Jersey, March 2024. https://www.njpca.org/wp-content/uploads/2024/04/March-2024_NJPCA-Bifold-FQHC-Snapshot.pdf

[ii] Dulce Gonzalez et al. Mixed-Status Families and Immigrant Families with Children Continued Avoiding Safety Net Programs in 2023. Urban Institute, Aug. 7, 2024. https://www.urban.org/research/publication/mixed-status-families-and-immigrant-families-children-continued-avoiding

[iii] Marleina Ubel, New Immigrants Drive Economic Growth in New Jersey, New Jersey Policy Perspective, Apr. 15, 2024. https://www.njpp.org/publications/report/new-immigrants-drive-economic-growth-in-new-jersey/

[iv] Neeraj Kaushal and Felix Muchomba. Cost of Public Health Insurance for US-Born and Immigrant Adults. JAMA Network Open. 2023;6(9):e2334008. doi:10.1001/jamanetworkopen.2023.34008

Federal Leaders Should Preserve the Quality of SNAP Data to Protect Program Integrity

Posted on by Brittany Holom-Trundy

Attn: James C. Miller, Administrator
Food and Nutrition Service
United States Department of Agriculture
1320 Braddock Place, 5th floor
Alexandria, Virginia 22314

Re: Notice of Proposed Rulemaking: Supplemental Nutrition Assistance
Program: Rescission of Changes to Civil Rights Data Collection Methods,
90 F.R. 20825 (RIN 0584-AF19, May 16, 2025)

Dear Mr. Miller:

I am writing on behalf of New Jersey Policy Perspective (NJPP) in response to the U.S. Department of Agriculture’s (USDA) Food and Nutrition Service (FNS) proposal to rescind the Supplemental Nutrition Assistance Program (SNAP): Revision of Civil Rights Data Collection Methods final rule, which ended the practice of visual observations to determine SNAP participants’ race or ethnicity. I appreciate the opportunity to provide comments expressing our concerns with this change in data collection methods.

NJPP strongly disagrees with the proposed rescission, which would reinstate the allowance of visual observation as a program standard for the collection of race and ethnicity data of participants. This would be a step backward for the reliability and accuracy of data and would threaten the fair administration of SNAP. We recommend that the rule remain in place to continue improved data collection practices, maintain the accuracy of program analyses, and respect the civil rights of participants. 

The quality of data significantly impacts its usefulness, including the potential scope and accuracy of analyses that can be produced. In the case of visual observation of race, studies have shown that conclusions using this practice are often inaccurate when compared with self-reported data by the person whose race is being evaluated, if the goal is to determine the individual’s identity, family background, and lived experience.[i] Additionally, the perceptions of the interviewers or administrators visually observing race can vary, resulting in errors that do not follow predictable patterns or allow for reliable adjustments when evaluating the data. This makes it more difficult to produce program evaluations with high levels of confidence in their accuracy.[ii]

In addition to the accuracy of data collected, visual observation of race and ethnicity as a practice can threaten the process of the interview itself. Establishing a standard practice of asking an interviewer to potentially report the race or ethnicity of an interviewee primes the interviewer to think about and evaluate the characteristics of the participant throughout the interview. This can lead to an increase in biases within the interviewer’s approach and harm their rapport with the interviewee.

By diminishing the reliability and accuracy of demographic variables like race and ethnicity, any analyses that look to determine whether SNAP continues to be administered in ways that comply with federal civil rights requirements will be limited in their ability to confidently produce accurate results. Although allowing the interviewer to report the suspected race or ethnicity of a participant may lead to fewer unreported results and increase the number of “complete” questionnaire responses, the filling in of these gaps with unreliable data further reduces the data’s utility and harms program administration and outcomes.[iii] Researchers, program analysts, and lawyers would face greater difficulties reporting on the quality of the program’s administration and its legal standing with regard to civil rights requirements.

If officials are interested in filling gaps in the program data reported and wish to develop methods of producing more complete files, they must recognize that the most reliable and accurate data will come from the participant, who knows their family and individual background and identification. In order to encourage participants to answer this sensitive question more often, officials should look to methods of building trust between caseworkers and participants, improve and promote the security of the data provided, as well as adjust the structure of the questionnaire and potential answers to best allow for the participant to answer fully and accurately.[iv]

Due to the concerns outlined above, NJPP opposes the proposed rescission of this rule and hopes that the Department will consider other methods of filling data gaps and improving the overall quality of program evaluations.

Sincerely,

Brittany Holom-Trundy
Senior Policy Analyst
New Jersey Policy Perspective

End Notes

[i] Note that if the goal of a study is to record the race or ethnicity that external people may observe — thus, studying biases in observations — then the reporting of a visual observation of race and ethnicity would be valid in terms of what it seeks to capture. However, with program data, the aim is generally to better administer the program and ensure that there are no unintended or intended exclusions of communities based on their demographic characteristics.

[ii] This is not just a challenge for visual observation of race and ethnicity, but is also a broader challenge for any externally imposed completion of missing race and ethnicity data. For a discussion of statistical challenges, see Megan Randall, Alena Stern, and Yipeng Su (2021), “Five Ethical Risks to Consider Before Filling Missing Race and Ethnicity Data,” Urban Institute,

https://www.urban.org/sites/default/files/publication/103830/five-ethical-risks-to-consider-before-filling-missing-race-and-ethnicity-data-workshop-findings.pdf.

[iii] The USDA’s Civil Rights Impact Analysis for the original rule recognized that the removal of visual observation as standard practice would increase the accuracy of its data: https://www.federalregister.gov/d/2022-13058/p-35. Without additional study results showing outcomes to the contrary, the reinstatement of the practice remains unsupported and should be considered to most likely decrease accuracy.

[iv] The ability of participants to fully answer the question in a way that they identify as accurate can significantly impact the response rates and the validity of the data. See, for example: Garbarski, Dana, Jennifer Dykema, Cameron P. Jones, Tiffany S. Neman, Nora Cate Schaeffer, and Dorothy Farrar Edwards (2024), “Questioning Identity: How a Diverse Set of Respondents Answer Standard Questions About Ethnicity and Race.” Field Methods 36, no. 2: 113-130. For an in-depth discussion of data collection on race and ethnicity, see Sharghi, Sima, Shokoufeh Khalatbari, Amy Laird, Jodi Lapidus, Felicity T. Enders, Jareen Meinzen-Derr, Amanda L. Tapia, and Jody D. Ciolino. “Race, ethnicity, and considerations for data collection and analysis in research studies.” Journal of Clinical and Translational Science 8, no. 1 (2024): e182.

Legislators Must Protect the Rights of New Jerseyans & Invest in Long-Term Solutions for Mental Health Care

Posted on by Brittany Holom-Trundy

Good morning Chairman Vitale and members of the Committee. Thank you for this opportunity to provide my testimony in opposition to S4263. My name is Dr. Brittany Holom-Trundy, and I am a senior policy analyst at New Jersey Policy Perspective (NJPP). NJPP is a non-partisan, non-profit research institution that focuses on policies that can improve the lives of low- and middle-income people, strengthen our state’s economy, and enhance the quality of life in New Jersey.

NJPP strongly opposes the permanent extension of involuntary commitment length, which threatens the health and rights of New Jersey residents. The role of involuntary commitment in treatment for those experiencing mental health crises has long been recognized as complicated and, often, problematic. Research has shown that racism, sexism, and other biases in health treatment settings lead to disparities not only in judgments about people’s pain or illness, but also in diagnoses of psychological disorders.[i] Because involuntary commitment requires medical judgments from healthcare professionals about whether a person is a “danger to self” or “danger to others or property,” emphasizing these situations further as a blunt tool for care without needed data opens doors to increased discrimination.[ii] Studies have shown that patients of color are more likely to be determined to be a “danger” and involuntarily committed than white patients.[iii] Meanwhile, there remains very little research on the medical effectiveness of 72-hour holds, let alone double that amount of time.[iv]

Though involuntary commitment may be necessary as a blunt tool to address an emergency situation, it is certainly not the ideal approach to care, and not one that should be prolonged arbitrarily. Hospitals often do not have the resources necessary to provide the standard of care for patients in involuntary commitment throughout its original 72-hour length; thus, extending the possible length of time simply invites worsening conditions resulting from staff and resource shortages.

The need for extended involuntary commitment remains low, and when it is utilized, it indicates other gaps in care. According to quarterly reports submitted to the Department of Human Services since the initial introduction of this extension, facilities requested extended holds for less than 1-2% of all hospitalizations due to psychiatric crises.[v] This means that these holds were needed for less than 1% of all patients screened for mental health crises, most of whom are discharged without hospitalization.

Such a small number does not indicate a pressing need to permanently suspend patients’ rights to reasonable, humane treatment in the standard timeframe. Instead, if our goal as leaders is to improve care, further decrease the number of cases in need of involuntary commitment, and address challenges within that system, then we must consider the question of why these patients were in need of help and were unable to receive that help within 72 hours (3 days), which should be achievable. In particular, attention to the following would allow for a better, more targeted response:

  • Whether and where beds were available at the time of the hold
  • Staff shortages at the facility holding the patient
  • Reports of refusals to accept patients based on complicating medical conditions, criminal history, insurance status, or other circumstances
  • Insurance status of patients held and payments charged

By considering these factors, lawmakers could determine if more psychiatric facilities and beds are needed; if increased staffing at hospitals should be prioritized; if staff need improved training, regulation, or support; or if facilities have financial incentive to keep some patients longer than others. Addressing these root causes of issues would provide better long-term solutions than the band-aid of simply extending involuntary commitment. Leaders could seek to invest state resources into long-term solutions to improve the mental health system so that we can decrease the number of people reporting mental health crises, improve treatment for those experiencing crises, and ensure the best, most efficient use of hospital care settings for both patients and healthcare workers.

New Jersey needs long-term investment in the mental health system, not a self-fulling solution that invites further abuse and ignores the cause in the first place.

We hope that the Committee will agree and hold this bill and consider these concerns today.

Thank you for your time.

End Notes

[i] Hamed, Sarah, Hannah Bradby, Beth Maina Ahlberg, and Suruchi Thapar-Björkert. “Racism in healthcare: a scoping review.” BMC Public Health 22, no. 1 (2022): 988; Zhang, Lanlan, Elizabeth A. Reynolds Losin, Yoni K. Ashar, Leonie Koban, and Tor D. Wager. “Gender biases in estimation of others’ pain.” The Journal of Pain 22, no. 9 (2021): 1048-1059; Garb, Howard N. “Race bias and gender bias in the diagnosis of psychological disorders.” Clinical Psychology Review 90 (2021): 102087.

[ii] Morris, Nathaniel P. “Detention without data: public tracking of civil commitment.” Psychiatric Services 71, no. 7 (2020): 741-744.

[iii] Shea, Timothy, Samuel Dotson, Griffin Tyree, Lucy Ogbu-Nwobodo, Stuart Beck, and Derri Shtasel. “Racial and ethnic inequities in inpatient psychiatric civil commitment.” Psychiatric Services 73, no. 12 (2022): 1322-1329.

[iv] Morris, Nathaniel P. “Reasonable or random: 72-hour limits to psychiatric holds.” Psychiatric Services 72, no. 2 (2021): 210-212.

[v] New Jersey Department of Human Services. Continued Hold Orders. https://nj.gov/humanservices/dmhas/publications/orders/

House Proposal Would Strip Health Coverage From 200,000 New Jerseyans, NJPP Warns

Posted on by Brittany Holom-Trundy

On Monday, May 12, the U.S. House Energy and Commerce Committee released its plan to cut Medicaid by over $700 billion. Debate on the bill begins Tuesday, May 13 — the next step that would take health insurance coverage away from 8.6 million people. Three members of New Jersey’s congressional delegation sit on the committee: Reps. Frank Pallone (D), Robert Menendez, Jr. (D), and Thomas Kean, Jr. (R).

In response, New Jersey Policy Perspective (NJPP) issues the following statement.

Brittany Holom-Trundy, Senior Policy Analyst, NJPP:

“The House plan to cut Medicaid would strip hundreds of thousands of New Jerseyans of their health insurance and roll back more than a decade of progress in making health care more affordable.

“Whether through block grants, work requirements, or other means, the outcome is the same: 8.6 million Americans would lose their insurance — including nearly 200,000 New Jerseyans, if cuts are distributed evenly across the states.

“These cuts are a direct attack on the health and well-being of families working hard to make ends meet.

“New Jersey cannot afford to reverse its successful, bipartisan Medicaid expansion just to pay for more tax breaks for billionaires and large corporations.”

For more on how proposed Medicaid cuts would harm New Jersey, read NJPP’s March publication on the impact of work requirements.

###

Federal Medicaid Reductions Would Have Disastrous Effects on New Jersey’s Communities

Posted on by Peter Chen

Good morning Chair and members of the committee. Thank you for the opportunity to testify.

Any reduction in federal Medicaid spending directly harms New Jersey’s budget and its residents. As a state-federal partnership, Medicaid depends on reliable and sustainable federal funding to balance state funds. Regardless of the specific method that Medicaid spending is cut, the end result is the same: less money for the state and costs pushed from the federal budget onto state budgets.

A $2 billion cut, no matter how you slice it

Analysis from national health care researchers estimates that the proposed cuts in the federal Medicaid budget would mean a $2 billion annual cut in New Jersey’s Medicaid budget. (See Appendix A). This corresponds with analysis by New Jersey’s Department of Human Services putting a cost of a minimum of $2 billion on proposed federal changes. (See Appendix B)

By way of comparison the entire proposed state appropriation for Medicaid is $5.7 billion for FY 2026.[i] Another way of contextualizing the numbers – the estimated cuts are the equivalent to the cost of 87% of kids enrolled in Medicaid. (See Appendix A)

I will leave to other experts to discuss the mechanics of particular proposals, whether a per capita cap, a change in federal reimbursement rate, or onerous work requirements. But regardless of the method, the state budget will face a multi-billion dollar hole with no solution.

A trickle-down budget disaster for states, localities, and health care providers

The state budget would take the immediate cut from whichever federal cuts are realized. Some of that effect may be spread out over multiple years but one way or another, the money will stop showing up in the state’s revenues.

But the ripple effects of these cuts would eat even further into the state’s budget.

  • If the state chooses to fill in the federal gaps with its own funding, it would have to generate new revenues to do so at a time when the budget is already running deficits.
  • If people become disenrolled from Medicaid, they will likely incur costs elsewhere in the health care system, whether in hospital charity care or other uninsured settings.
  • Health care providers depend on Medicaid payments, as detailed in the NJ DHS analysis (See Appendix B), and funding cuts would affect their revenues as well.

 

Limited solutions

Reducing costs for Medicaid at the state level would be difficult for a program that already runs at very low cost compared to the private insurance market. Medicaid costs less to insure an enrollee than the private market and spending has grown more slowly than the private market.[ii]

  • Already-low reimbursement rates: New Jersey already has comparatively low reimbursement rates for Medicaid,[iii] limiting options for provider availability if rates are capped or reduced.
  • Already-low overhead costs: Overhead costs for Medicaid are already low – around 4.4% for New Jersey.[iv]
  • Increased administrative costs of proposed changes: Creating a state system for work requirements or other potentially onerous federal mandates would increase, not decrease, those administrative costs.

One additional note of caution: recessions typically see an increase in demand for Medicaid, as people become unemployed or underemployed.[v] If economic uncertainty produces a recession, this would further increase the state budgetary cost of reduced federal Medicaid spending. In the 2001, 2008, and 2020 recessions, the federal government increased Medicaid reimbursement rates, but that may be unlikely this time around.

The takeaway: A Medicaid cut by any name would impose huge costs on the state budget, with few solutions and devastating effects on New Jerseyans’ health.

End Notes

[i] State of New Jersey, The Governor’s FY 2026 Budget: Detailed Budget (2025), p. D-209.

[ii] Hannah Katch et al., Frequently Asked Questions about Medicaid, Center on Budget and Policy Priorities (Nov. 22, 2019), https://www.cbpp.org/research/correcting-seven-myths-about-medicaid

[iii] New Jersey Health Care Quality Institute, Primary Care in New Jersey: Findings and Recommendations to Support Advoanced Primary Care (January 2024) https://www.njhcqi.org/wp-content/uploads/2024/01/Primary-Care-Report_2024_v11.pdf.

[iv] Medicaid and CHIP Payment and Access Commission (MACPAC), MACStats: Medicaid and CHIP Data Book (December 2024), p. 46 exh. 16, https://www.macpac.gov/wp-content/uploads/2024/12/EXHIBIT-16.-Medicaid-Spending-by-State-Category-and-Source-of-Funds-FY-2023.pdf.

[v] Katherine Young et al., Medicaid Spending Growth in the Great Recession and Its Aftermath, FY 2007-2012, Kaiser Commission on Medicaid and the Uninsured (July 2014), pp. 5-6, https://www.kff.org/wp-content/uploads/2014/07/8309-03-medicaid-spending-growth-in-the-great-recession-and-its-aftermath-fy-2007-2012.pdf

Medicaid Cuts and Red Tape Jeopardize Health Care for Over 750,000 New Jerseyans

Posted on by Peter Chen

Every New Jerseyan deserves access to affordable health insurance and care. Medicaid coverage ensures that people can see a doctor for routine checkups and essential care, improving overall health and reducing medical debt for enrollees. However, recent federal proposals to slash Medicaid funding for states threaten gains in coverage for adults and children across New Jersey. Federal Medicaid dollars support New Jersey FamilyCare, which provides health insurance for low- and moderate-income households — making it a critical lifeline for families statewide.

Under the recently passed House budget resolution, one harmful proposal would impose work requirements for Medicaid. If Congress passes these onerous work requirements, about 765,000 New Jersey adults could lose health insurance — 44 percent of all adult Medicaid enrollees. Other estimates, including from the New Jersey Department of Human Services, which administers Medicaid in New Jersey, conclude similarly, showing that hundreds of thousands of people risk losing health insurance with work requirements under these rules.

Overall, these counterproductive requirements would add burdensome and unnecessary red tape to insurance applications while threatening basic health insurance for nearly half of all enrollees. Most adult Medicaid enrollees already work, while those who are not are most often caring for family members, dealing with illness or disabilities, or pursuing education. Evidence from states with work requirements for health insurance demonstrate that these policies fail to increase employment, while access to affordable health insurance actually improves a person’s ability to get and keep a job.

Cuts that remove people from Medicaid shift costs onto working- and middle-class families who rely on it. These families already face rising housing, food, and health care expenses. If a New Jersey family in the lowest 20 percent of earners lost coverage, they would lose, on average, $11,909 annually.

New Jersey must protect NJ FamilyCare by rejecting Medicaid cuts that would undermine affordability, strain the state’s budget, and put hundreds of thousands of New Jerseyans at risk of losing lifesaving health insurance.

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