Lilo H. Stainton, who recently joined the New Jersey Monitor staff to write about health care policy, talks about what to expect from big changes coming to Medicaid and public health in general in the Garden State.
What are some of the big challenges facing New Jersey public health officials in the next four years?
Public health officials working on the frontlines to keep communities healthy are still wrestling with serious funding and workforce challenges. These problems long predated COVID-19, but have grown as federal grants have been cut and workers face burnout and retire early or move to less stressful jobs. I know of several towns and counties that have lost nurses, disease trackers, and other staff over the past year.
Add in the rise in anti-science and anti-vaccine sentiment, which has left all of us more vulnerable to diseases like COVID-19 and the flu, and public health officials say they are seriously concerned about how to protect New Jersey from the next pandemic.
Keep in mind, measles is spreading fast in parts of this country, and we’ve had multiple isolated cases detected in New Jersey over the past year. Earlier this month, an infected person spent much of the day at a pediatric emergency room in New Brunswick — as a visitor, not a patient — triggering the need for public health announcements, disease tracking, and other public health work.
There’s been a push to get the state to dedicate more funding for public health infrastructure, with advocates urging state lawmakers to approve $10 million annually, but so far it hasn’t happened. It’s not clear if this will be a priority for our new governor, Mikie Sherrill, who picked a public health leader to head up the state health department, but local public health folks are watching closely to see if she includes new funding in the state budget plan she must reveal soon.
What changes are expected for people on Medicaid?
Medicaid, or NJ Family Care, now insures nearly 2 million people in New Jersey. It also covers the cost of 40% of the babies born here and some two-thirds of the nursing home residents. Some people will lose coverage entirely and others will need to file more paperwork to maintain their benefits, all thanks to the massive overhaul of the federal- and state-funded program that President Trump signed in July. State health care experts have said this will cost New Jersey more than $3 billion in federal funding in the years to come and could leave 360,000 Medicaid members uninsured.
It won’t happen all at once. In New Jersey, as many as 25,000 legal immigrants are expected to lose coverage this year because of a change to federal guidelines. The big pressure point comes in January 2027, when some 550,000 Medicaid recipients here — largely low-income workers who gained coverage after the Affordable Care Act expanded the program’s scope — will need to prove they are working, in job training, or volunteering at least 20 hours a week to continue receiving health care benefits.
What do we know about this work requirement?
The work requirement only applies to people who qualified for Medicaid through the Affordable Care Act expansion, and there are some exceptions, like if you are caring for a child or disabled parent or are “medically frail.” It’s not clear yet how that’s going to be defined.
New Jersey officials, who are writing the rules for the program, have promised to keep as many people covered as possible through Medicaid, but the federal government has the final say on who must prove what to get insurance. There’s research that shows nearly two-thirds of Americans on Medicaid already have a job, are caring for kids or sick relatives, or are in school, but starting next year, they will need to be able to document this use of time.
Experts say all the extra red tape will probably drive more than 300,000 New Jerseyans out of the Medicaid program; nationwide, some 5 million people are expected to lose benefits through work rules requirements. And that’s the point for the Trump administration. Fewer people on Medicaid means lower costs for the federal government, which pays for more than 60% of the program in New Jersey. But their health care needs don’t go away, of course, and the fear is that more people will end up using the emergency room for regular care. And when emergency room patients are uninsured, much of that cost ends up falling to state taxpayers.
Are any changes for Medicare in store?
Medicare, which is funded and run by the federal government, isn’t slated for changes at the moment, but federal Health and Human Services Administration Secretary Robert F. Kennedy Jr. has made clear he’s a fan of Medicare Advantage plans, or part C plans. This is coverage funded through Medicare, but administered by private health insurance companies. Patient advocates have raised a lot of red flags about these plans, which now cover roughly half of all Medicare members nationwide, because while they offer some great benefits (think gym membership, money for healthy food) that aren’t part of the government-run plan, there are also limitations that sometimes come as a surprise to seniors, like network limitations on what doctors are covered.
Are there other changes from D.C. that could affect New Jerseyans’ health?
Yes, many. The Trump administration cut $120 million from child welfare services, money New Jersey has used to drastically reduce the number of kids in foster care and help families stay together. The state lost at least $200 million in funding for SNAP, or food stamps, which helps feed more than 800,000 residents, nearly one-third of whom are disabled and 1-in-5 are seniors. There have been cuts to local public health grants and reductions in funding for addiction treatment services. All of this puts even more pressure on Sherrill and state lawmakers, who now have to craft and adopt a budget that either cuts services to tens of thousands of residents or turns to state taxpayers to fill the gap.
What’s happening with Obamacare plans?
There was probably sticker-shock for many people with Obamacare plans, the commercial insurance policies sold through government-run online marketplaces like Get Covered New Jersey. These are policies for people who earn too much to qualify for Medicaid, but don’t get health insurance through work.
Congress is still fighting over whether to restore the expanded federal subsidies that helped millions of people nationwide afford these policies, a debate that has already triggered two government shutdowns. Without federal aid for 2026 plans, the premium price for these plans was expected to soar nationwide.
New Jersey has also offered subsidies to help people with lower incomes afford Obamacare plans, and in the past, half the customers paid less than $10 a month out of pocket for these policies. But the cost of all health insurance keeps going up — rates are almost 17% higher this year for state-regulated plans in New Jersey, compared to 2025 — and when you also consider the loss of federal aid, Obamacare consumers faced costs that were 174% higher than last year, according to state insurance regulators. Even so, nearly 500,000 people had signed up for plans by early January, almost the same number who enrolled last year.
Stainton’s hiring is made possible by grants from the Robert Wood Johnson Foundation, the New Jersey Civic Info Consortium, EQUIP-NJ, and the Center for Cooperative Media at Montclair State University.
