New Jersey’s next governor is facing major changes to Medicaid. Neither leading candidate offers specifics on how they would tackle them. (Photo by Scott Olson/Getty Images)
New Jersey’s next governor will be faced with major changes to Medicaid, with more than half a million New Jerseyans likely navigating new work requirements by the end of next year and an eventual loss of about $2.5 billion in federal aid annually.
The leading candidates for governor — Jack Ciattarelli (R) and Mikie Sherrill (D) — both pledge to protect health care for New Jersey’s most vulnerable residents as the changes to Medicaid championed by the Trump administration start to take full effect. But they have very different views on what it means for the state budget, the health care system, and the 1.9 million residents who receive care through the state’s Medicaid program, NJ Family Care, many of whom have low income or a disability.
Democrat Mikie Sherrill said she would fight to protect children’s access to doctors and battle President Donald Trump to recover federal funds slated to soon disappear. Republican Jack Ciattarelli said people who are truly eligible for Medicaid can count on him to protect their care. Both say the other is wrong for New Jersey.
“Jack supports Trump’s efforts to rip away health care from more than 300,000 New Jerseyans and double premiums for another 450,000. Jack is one of the loudest cheerleaders for Trump’s budget that is detrimental to New Jersey,” said Sherrill campaign spokesperson Sam Chan. “While Jack talks a big game about being a CPA, his math just doesn’t add up.”
Ciattarelli campaign strategist Chris Russell, meanwhile, noted that Sherrill’s party has controlled the governor’s office for eight years and the Legislature for more than two decades.
“Democrats completely control Trenton and look at what has happened to the state. Why would we give Phil Murphy his third term with Mikie Sherrill?” Russell said.
Neither candidate offered specifics on how they would sustain the program as federal funding declines, or fund the cost of caring for New Jerseyans who lose coverage, but both on the campaign trail stress the need to make health care in general more accessible and affordable. Ciattarelli and Sherrill are seeking to replace Murphy, a Democrat who is barred from seeking a third term this year. Election Day is Nov. 4. Early in-person voting is underway.
By 2032, the changes launched by the Trump administration are expected to cost New Jersey more than $3 billion annually in Medicaid dollars, according to state policy analysts. An estimated 350,000 low-income residents will have lost NJ Family Care coverage, they said. Federal support for child welfare, food aid, and other services has also been slashed under Trump, further reducing revenue for New Jersey programs.
Sherrill, in her fourth term in Congress, has warned these shifts would be dangerous to residents and the state budget, and said during the first gubernatorial debate in September that the federal actions “will imperil the health care of 1 in 3 children” nationwide. Medicaid spending comprises more than 40% of the current state budget of nearly $60 billion.
In response to a question about changes in Medicaid, Chan, the Sherrill campaign spokesperson, said Sherrill “will take on anyone to ensure that New Jersey’s children don’t lose access to their doctor.”
“As governor, she will work to ensure we have the resources to ensure people can afford to see their doctor. Mikie will take Trump to court to claw back as much money as we can, develop innovative partnerships with health care providers and hospitals to provide preventive care at a low cost, and crack down on tax cheats at the state level and use this funding to lower costs for New Jersey families,” Chan said.
Ciattarelli, a retired businessman who has served in local, county, and state government, has largely downplayed the potential impact of changes to Medicaid and said his positive relationship with Trump, who endorsed him, will benefit New Jersey more than Sherrill’s legal threats. He said government spending on the state and federally funded health care program has increased in ways that are unsustainable, prompting a need for reform.
“I promise you that no vulnerable populations will be underserved in New Jersey under Governor Ciattarelli. Somehow, someway we will make sure they are taken care of,” Ciattarelli said at a Nutley campaign event earlier this month.
New Jersey allocated $24.3 billion for Medicaid through next spring in the budget Murphy signed in late June, of which $14.9 billion is expected from Washington, D.C. In addition to funding health insurance benefits and subsidizing hospitals — more than $2.6 billion this year, much of it for care in poor communities — the program pays for roughly 40% of all births in New Jersey and almost two-thirds of nursing home beds.
Russell, the Ciattarelli campaign strategist, said as governor, the Republican would “set responsible spending priorities and pull the plug” on funding for the pet projects of Democratic lawmakers. Those projects added $700 million to the current state budget. Democrats now hold majorities in the Assembly, where all 80 seats are up for election this year, and in the Senate.
“The idea that state money doesn’t exist to fund key priorities, whether that be health care, infrastructure, or education, is simply unfounded,” Russell said, pointing to budget growth in recent years. “Jack has said repeatedly that as governor, people who qualify for Medicaid and rely on the program will be taken care of under a Ciattarelli Administration.”
The most immediate change coming to Medicaid is the addition of work requirements for most adults, a provision that would impact some 550,000 people in New Jersey, according to policy experts at the state Department of Human Services, which runs the program. By 2027, adults must spend — and be able to document — at least 20 hours a week at a job, in school, or performing community service. Women who are pregnant or have recently given birth, caring for someone who is disabled or under age 13, or attending addiction treatment would be exempt, they said.
The work requirements, which studies show have not been highly successful elsewhere, come with changes to Medicaid rules that force participants to verify they are eligible twice a year, instead of just once, as is now the case. Policy experts predict the new rules will lead some 350,000 residents to drop their NJ Family Care plans, reducing the cost to the federal government.
Over time the additional red tape is also likely to double the workload for state and county employees, state policy experts say.
Ciattarelli has echoed national Republicans in describing the work requirements and eligibility changes as fair and necessary to protect the program’s integrity.
Ciattarelli also defended Trump’s insistence on implementing nationwide work requirements in Medicaid (states havesignificant control in how these are established).
“It’s not to be mean. It’s because billions are being wasted on people who are scamming the system,” he told the cheering crowd in Nutley. “So what measures do you put in to stop the scamming of the system?”
Medicaid is monitored at the state and federal levels to identify fraud and other problems, with New Jersey watchdogs identifying more than $1 billion in fraud, overpayments, or wrongful payments in the past decade. But experts note these improprieties are not as common, or as costly, as Republicans suggest.
Ciattarelli said he also supports removing undocumented immigrants from the program. New Jersey is one of 14 states, plus Washington, D.C., that use local tax dollars to insure undocumented children, according to non-partisan health care advocates at KFF, and it expects to spend about $164 million this year to cover 47,000 of these youngsters.
Federal changes to Medicaid will also end coverage for various legal immigrants starting next year, which state experts said will remove some 25,000 people from NJ Family Care, including refugees and victims of domestic violence and human trafficking.
The full financial impact of the federal Medicaid changes starts to take effect in 2028, in the middle of the next governor’s four-year term in office. That’s when the new law begins to limit how states can use Medicaid to generate funding for hospitals and other services, an approach New Jersey has embraced under Murphy.
New Jersey has used much of this revenue to replace charity care, the longstanding hospital aid program that relies more heavily on state tax dollars than Medicaid. The implementation of the Affordable Care Act, which expanded Medicaid eligibility and created the market that sells Obamacare plans, started to drive down charity care numbers a decade ago. The increased reliance on Medicaid for hospital subsidies shrank the budget line even more, from $349 million in 2022 to less than $70 million in the current budget.
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