What’s New?

What Do We Know About the “Medically Frail”?

Posted on September 2, 2025

Riyah Myrie, Summer Intern
Authored by:
Riyah Myrie
Summer Intern

Portions of the One Big Beautiful Bill Act, signed by President Trump on July 4, amended parts of the Social Security Act that outlined the requirements for a State plan for medical assistance, commonly known as Medicaid, and the Children's Health Insurance Program (CHIP). In New Jersey, our state public health insurance program is NJ FamilyCare.

What Changed in Medicaid and CHIP?

The law now requires states to:

  • Reduce duplicate enrollments in Medicaid and CHIP.
  • Ensure that deceased individuals are removed from enrollment rolls and that no payments are made on their behalf.
  • Establish Medicaid “community engagement compliance” for certain individuals.

Lawmakers justify these measures as promoting “community engagement compliance” by encouraging work, reducing reliance on public assistance, and fostering self-sufficiency.

For working-age adults (ages 19–64) in the Affordable Care Act’s expansion group, the requirement is 80 hours of work or equivalent activity per month. As a medicaid expansion state, New Jersey adults apart in the program have to meet the work requirements.  This can be met through:

  • Traditional employment
  • Community service
  • School attendance
  • Having earned income equal to or greater than 80 × the federal minimum wage

Enrollees must verify compliance every six months. These new changes to Medicaid eligibility will start to be adopted on December 31, 2026. 

This new work requirement is said to be the strictest to be implemented so far in Medicaid history. However, not everyone can work 80 hours a month, especially people with significant health conditions. That’s where the “medically frail” exemption comes in. 

Working-age adults in the Affordable Care Act’s expansion group are exempt from the work requirement if they are:

  • Experiencing short-term hardship
  • Pregnant and postpartum members
  • Foster youth and former foster youth under the age of 26
  • Veterans with rated disabilities
  • Considered “medically frail”
  • Receiving care in certain substance use disorder treatment programs
  • Showing compliance with work requirements under TANF or SNAP
  • Incarcerated or recently incarcerated

What Does “Medically Frail” Mean? 

The bill defines a medically frail person as someone with “special medical needs” as determined by the Secretary of Health and Human Services. It lists specific examples: 

  • Blind or disabled individuals 
  • People with a substance use disorder 
  • People with a disabling mental disorder 
  • People with a physical, intellectual, or developmental disability that significantly limits their ability to perform one or more activities of daily living (ADLs) 
  • People with a serious or complex medical condition 

While this list offers examples, the term itself is vague. That vagueness has real consequences, and if you don’t know whether you qualify, you might fail to apply for an exemption you’re entitled to. 

This is not the first time “medically frail” has been used in federal law. It appears in the Affordable Care Act (ACA), the Food and Nutrition Act of 2008, the RAISE Family Caregivers Act, the Older Americans Act, and the Indian Health Care Improvement Act.

Medically frail means having a physical, mental, or medical condition so serious that it makes it hard or impossible to work, go to school, or do daily activities without significant help. This could be due to a chronic illness, a disability, a severe injury, or ongoing treatment that limits your ability to live independently. 

In short, if your health condition prevents you from sustaining steady work or normal daily function, you might qualify as medically frail.

Impact on New Jersey (NJ FamilyCare) 

Many people may not know that NJ FamilyCare is the state's version of Medicaid, or that New Jersey is part of the Medicaid expansion group. Medicaid offers free or low-cost health coverage to eligible residents who meet specific income and other requirements.

Under these new federal rules: 

  • Work requirements mean that more NJ FamilyCare recipients will have to track and report their employment or volunteer hours, resulting in increased paperwork.
  • Individuals who consistently miss deadlines or fail to provide required documentation may lose coverage, even if they still meet the qualification criteria. 
  • The Congressional Budget Office projects that the law will save the federal government over $1 trillion in the next decade, largely from people losing coverage due to eligibility changes and administrative hurdles. 

For many in New Jersey, especially in urban areas where jobs may be unstable or seasonal, meeting an 80-hour monthly work threshold could be challenging. This is compounded by the fact that the bill also introduces new cost-sharing (copays) for this group, making healthcare less affordable even for those who remain eligible. 

Impact on Children 

While children are not directly subject to work requirements, they are deeply affected when their parents or caregivers lose coverage. 

Here’s why: 

  • Loss of coverage for parents can make it harder for families to access preventive care, manage chronic conditions, and keep up with children’s health needs. 
  • Research shows that when parents are uninsured, their children are less likely to attend regular check-ups, even if the children themselves are still covered. 
  • If household income drops due to illness or loss of Medicaid coverage, families may struggle to afford medications, transportation to appointments, or healthier food, thus indirectly harming children’s well-being. 

For New Jersey specifically, where NJ FamilyCare enrollment for children is high, disruptions in coverage for adults could ripple into higher emergency room visits, poorer health outcomes, and greater strain on school-based health programs.

The exemption for the “medically frail” is critical, but its vagueness makes it hard for people to know if they qualify. Without clear, accessible guidance, many who should be exempt could fall through the cracks, potentially losing essential coverage.

For New Jersey, these changes will test the resilience of NJ FamilyCare, increase the administrative burden on families, and, most concerning, potentially harm children’s health outcomes. The challenge will be making sure the people who truly cannot work are identified, protected, and supported. 

The $50 Billion Rural Health Transformation: What It Means for Hospitals and Families

Posted on September 2, 2025

Riyah Myrie, Summer Intern
Authored by:
Riyah Myrie
Summer Intern

When Congress passed the One Big Beautiful Bill Act earlier this summer, most headlines focused on the sweeping tax cuts, new family incentives, and large-scale federal investment. However, the reconciliation bill included a provision from the Senate: a $50 billion commitment to rural hospitals, known as the Rural Health Transformation Program. 

What Does The Transformation Look Like?

The bill set aside $10 billion per year from fiscal years 2026 to 2030, creating a pool of $50 billion to be distributed. Of the $50 billion, half ($25 billion total, or $5 billion per year) is to be distributed by the Centers for Medicare and Medicaid Services (CMS) equally among all states with an approved application. They must submit detailed plans to the CMS by December 31, 2025, outlining how they will use the funds to stabilize and strengthen rural health systems. The remaining half is to be allocated by CMS within the broad requirements.

Rural hospitals account for roughly a third of all community hospitals nationwide, but many of them operate with thin or negative margins. Between 2017 and 2024, hospital closures in rural communities outpaced openings, leaving many families without local access to emergency rooms, maternity care, or even primary services. Even with the existing special Medicare payments, about half of rural facilities were still struggling as of 2023. 

What Does “Rural” Mean?

In the bill, “rural hospitals” encompass the following:

  • Hospitals physically located in rural areas
  • Critical access hospitals certified under Medicare
  • Sole community hospitals (often the only facility within 35 miles)
  • Medicare-dependent small rural hospitals 
  • Low-volume hospital that serves remote populations 
  • Newly designated rural emergency hospitals

Through capturing these categories, the program ensures hospitals serving isolated areas or sparsely populated areas are eligible for support. However, it does not guarantee support due to the loss of federal Medicaid funding, putting over 300 hospitals at risk of closing. 

Impact on New Jersey

The densest state in the nation, New Jersey, also currently has no federally designated rural hospitals. This raises questions about whether the state will see any direct benefit from the $50 billion fund.

Technically, all 50 states may apply for funding, but the provision will directly affect rural-heavy states such as Texas, Montana, and Mississippi. For New Jersey, this likely means no new dollars flowing directly into local hospitals.

Nonetheless, the policy may have indirect implications. If rural facilities in other states become stable, federal lawmakers might experience less pressure to further reduce Medicaid, a program that finances many births and assists low-income families throughout the state.

Impact on Children 

The stakes are especially high for children. Across the country, Medicaid covers nearly half of all rural births, with the vast majority of them occurring in hospitals. When rural hospitals close, pregnant people must travel farther for delivery, increasing their health risk. For children, losing rural pediatrics or emergency services often means delayed care and higher costs imposed on parents, with the addition of travel expenses. 

Even in New Jersey, though rural designations are scarce, the debate underscores a broader truth: children’s health outcomes are tied to the financial stability of hospitals everywhere. If rural health collapses in one region, it strains referral networks and specialty care nationwide. 

Every state will not benefit equally from the $50 billion Rural Health Transformation Program, and New Jersey may see little direct impact, but it underscores that rural health is on a fragile path and in serious need of support. For families across the country, the program could mean the difference between local hospitals staying open or shutting their doors, making the One Big Beautiful Bill Act more than just fine print.

The Future of Public Preschool: Building a Bold Vision Together – NJ’s first community-based private provider conference

Posted on September 2, 2025

Let's Build the Future of Public Preschool Together!

Join us on Thursday, October 16 at The Park Hotel at Meadowlands for New Jersey's First Community-Based Private Provider Conference: The Future of Public Preschool: Building a Bold Vision Together. This exciting one-day event brings together early childhood leaders, educators, and advocates committed to strengthening community-based public preschool partnerships across New Jersey.

Hosted by Advocates for Children of New Jersey and New Jersey Association for the Education of Young Children, and made possible thanks to our generous funders at The Henry and Marilyn Taub Foundation, this conference will explore everything from enrollment strategies and marketing, to leadership, teacher burnout, budget planning, certification and MORE. With multiple breakout sessions, networking opportunities, and inspiring keynotes; including featured guest DJ Pryor ⬇. You'll leave energized and equipped to drive bold change.

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Professional development credits available. 

Breakfast, lunch, and parking are included.

Register now! We’ll be sharing more details along the way, including additional featured keynotes, specific workshop sessions, and exhibits. Stay tuned!

DJ Pryor is more than just a name– it's a symbol of inspiration, laughter, and the power of giving back. With a heart full of love and a spirit dedicated to making a positive impact, DJ Pryor has become a renowned figure in the world of entertainment and philanthropy. As a devoted husband of 8 years to his wife, Shanieke Pryor, and a proud father of three incredible children– Jabari (12), Kingston (5), and Zaria (2)– DJ's personal life serves as the foundation for his boundless creativity and determination.

With a career spanning two decades, DJ Pryor is a veteran stand-up comedian who has mastered the art of bringing joy to audiences around the world. His comedic genius has garnered not only laughter but also critical acclaim, resulting in an array of awards and recognitions. Beyond the stage, DJ's talents extend to acting, writing, motivational speaking, producing, and directing, showcasing his multifaceted abilities and his unwavering commitment to artistic excellence. But DJ's impact reaches far beyond the entertainment industry. He is the visionary CEO of DJ Pryor Inc and Laughter Is Universal Productions, platforms that allow him to channel his energy and expertise into creating meaningful content that resonates with people of all walks of life.

However, what truly distinguishes DJ Pryor is his genuine heart and dedication to philanthropy. Fueled by his desire to uplift underserved communities like the one he grew up in, he founded the Pryor To Change Global nonprofit foundation. This foundation serves as a beacon of hope, aiming to provide overlooked communities with essential resources, knowledge, and inspiration.

DJ's own journey of triumph over childhood trauma has transformed into a message of resilience and purpose that he shares wholeheartedly through his foundation's initiatives. DJ's global impact recently soared to new heights with a heartwarming video that captured a candid moment between him and his youngest son. This touching video went viral, amassing an estimated half a billion views across various web and social media platforms. Through this viral sensation, DJ has become one of the world's most influential voices on early childhood development. His story is a testament to his ability to turn personal challenges into opportunities for growth and change. Above all, DJ Pryor's mantra is rooted in service, empathy, and love. He believes that his talents are gifts meant to be shared with others, and he strives to embody these principles in every aspect of his life. As he humbly states, "My job is to always show love & empathy through my abilities and talents, GOD lives in me." In a world where laughter, love, and community are needed more than ever, DJ Pryor stands as a shining example of how one person's dedication can make a profound impact on the lives of many. His journey is a reminder that through compassion and creativity, we can all strive to create a brighter, more connected world.

Birth Centers Bring Dignity, Choice, and Health Equity to New Jersey Families

Posted on August 25, 2025

Trinisha Williams Headshot
Trinisha Williams, CM, MPH
President, American Association of Birth Centers (AABC)

As a midwife, an aunt, and a community advocate, I’ve spent over two decades walking alongside birthing people through their most intimate, powerful moments. I've seen firsthand how and where someone gives birth can shape their entire story—not just physically, but emotionally, spiritually, and culturally.

Right now, in too many places across New Jersey, the only option is a hospital. Families often don’t have access to birth centers, even if they are low-risk, healthy, and want a different experience. We must be clear: If there is only one option, then there is no real choice.

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Why Birth Centers Matter

Birth centers are not a luxury. They are an evidence-based, cost-effective, and community-centered model of care that has been proven to:

Birth centers are staffed by midwives and care teams who provide high-touch, low-intervention support. They care for people who are healthy and low-risk, and desire a more personalized birth experience. The centers offer services that matter deeply to families, such as water birth, continuity of care, and provider-to-patient ratios that allow for trust, education, and support. They also meet people where they are, with a deep respect for spiritual and culturally-rooted traditions, family structures, and lived experiences.

Addressing Birth Trauma with Compassionate Care

Far too many birthing people in New Jersey walk away from their births feeling unheard, dismissed, or even harmed. Birth trauma is real, and it’s a public health issue especially among Black and Brown families who face bias, neglect, or coercion in traditional hospital settings.

Birth centers provide a trauma-informed approach that centers on:

  • Continuity of care: the same team before, during, and after birth
  • Informed consent: making sure birthing people are active participants in their care
  • Emotional and physical safety: with time, space, and personalized support
  • Non-clinical comforts: like water birth, mobility, and uninterrupted bonding

When families feel respected and cared for, they are more likely to heal fully, bond deeply, and return to their communities stronger and more empowered.

A Solution to New Jersey's Maternal Health Crisis

New Jersey has one of the worst maternal mortality rates in the country; and the statistics are even more devastating for Black mothers, who are seven times more likely to die from pregnancy-related causes than their white counterparts.

We cannot afford to ignore these outcomes. We cannot keep pouring money into a system that was never built for all of us. We must fund, license, and support birth centers across New Jersey— especially in the neighborhoods where outcomes are worst, and where community-rooted, culturally responsive care is most needed.

Reclaiming Power and Choice

At the heart of midwifery care and birth centers is a simple truth: Birth belongs to the birthing person. When families are educated about their options and supported in their choices, they are empowered and healthier.

We need policies that:

  • Expand access to birth center care statewide.
  • Protect Medicaid and insurance coverage for birth center services.
  • Invest in Black- and Brown-led midwifery care models.
  • Build new birth centers in underserved areas, including South Jersey, rural communities, and urban perinatal health deserts.
  • Ensure midwifery autonomy by establishing a state Board of Midwifery.

To New Jersey’s Next Governor: Make Birth Centers Part of the Plan

We urge every gubernatorial candidate to include birth centers and midwifery-led care in their maternal health platform. If you are serious about saving the lives of birthing people in New Jersey, especially Black and Brown lives, then birth centers must be a part of your vision.

Let’s give families real options. Let’s shift from fear to trust. Let’s fund models that work.

Because birth should be safe. Birth should be sacred. Birth should be ours.

Why Wraparound Care is Essential

Posted on September 2, 2025

Co-Authored by:
Kyla Ginsberg
Student Intern

Cindy Shields
Early Childhood Senior Policy Analyst

Winifred Smith-Jenkins
Director of Early Childhood Policy and Advocacy

For more information on this topic, contact Cindy at cshields@acnj.org or Winifred at wsmith-jenkins@acnj.org.

For many families, the hours before and after school are just as important as the school day itself, making wraparound care essential for parents who work or go to school. Wraparound care, also called out-of-school time (OST), includes before-school programs, after-school programs, and summer care. It “wraps around” the traditional school day, providing children with safe, structured, and enriching activities while giving parents the support they need to work full-time. Far from being an add-on, wraparound care is a vital service that sustains families and strengthens local economies.

How the Need for Wraparound Care Emerged

Before the Industrial Revolution, child care in the United States was largely informal. As industrialization expanded in the late 1800s, families increasingly relied on two incomes, and stricter child labor laws limited children’s participation in the workforce. This shift created a pressing need for care outside the home. In cities like New York, Boston, and Philadelphia, “infant” or “day” nurseries emerged, providing safe spaces for children while their parents worked. By the 1970s-80s, concerns about unsupervised "latchkey kids" led to increased investment in structured after-school programming as more women joined the workforce.

A Defining Moment for Child Care Policy in New Jersey

In New Jersey, the 1980s marked a turning point in child care policy. Counties created Child Care Resource & Referral (CCR&R) agencies, and local subsidy programs soon followed. (Child Care Association of NJ) In 1983, the state passed the Child Care Center Licensing Act and the Family Day Care Registration Act, establishing regulatory standards for both center-based and home-based care. (ACNJ) The first voucher-based subsidy program was launched in 1984 by North Jersey 4Cs, enabling families in Passaic County to access affordable wraparound care. (North Jersey 4Cs)

Why Wraparound Care Matters Today

Wraparound care plays a critical role for both families and the broader economy:

  • Safety and Supervision: Provides children with a safe, nurturing environment beyond the school day.
  • Workforce Stability: Enables parents to maintain steady employment without compromising their children’s well-being.
  • Sustaining Child Care Centers: Revenue from wraparound care helps centers remain financially viable, ensuring that early learning programs continue to serve communities.
  • Economic Impact: Reliable child care, including wraparound services, is a cornerstone of workforce participation and economic growth.

Benefits for Children

High-quality wraparound programs go beyond supervision. They enrich children’s lives.

  • Academic Support: Many programs provide homework help, tutoring, and enrichment opportunities.
  • Social-Emotional Growth: Activities build relationships, teamwork, and resilience.
  • Health and Wellness: Programs often include outdoor play, clubs, and nutritious meals or snacks.
  • Closing Opportunity Gaps: For children from under-resourced families, before- and after-school programs provide access to experiences such as arts, sports,  and STEM that they might otherwise miss.

The Role of Child Care Subsidies in New Jersey

In New Jersey, the Child Care Assistance Program (CCAP), overseen by the Department of Human Services’ Division of Family Development, has been a critical lifeline for families. However, as of August 1, 2025, the program has stopped accepting new applications due to budget shortfalls. Families already enrolled will also face higher co-pays at their next redetermination.

Without robust funding for subsidies, the impacts may be far-reaching:

  • Parents may be forced to leave the workforce or reduce hours due to unaffordable child care costs.
  • Child care centers may limit services or close programs, reducing available options.
  • The broader New Jersey economy may experience disruptions as workforce participation declines.

Moving Forward

Wraparound care is not a luxury. It is a foundational service for families, children, and the economy. Ensuring that it remains accessible and affordable is a shared responsibility.

Questions for Policymakers:

  • How will you ensure equitable access to high-quality wraparound care for New Jersey families now and in the future?
  • What steps will you take to support and fairly compensate the child care workforce?
  • How will you address budget challenges to protect the subsidies that keep families working and children thriving?
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