What’s New?

Your Voice Matters: Help Improve Special Education Services in NJ

Posted on August 7, 2025

The New Jersey Department of Education (NJDOE) is in the process of reviewing N.J.A.C. 6A:14, which includes the regulations that govern how special education and related services are delivered to students across the state. This process presents an important opportunity to the public–including parents, caretakers, school staff, service providers, and advocates–to share their insights to help determine what, if any, changes might improve the law before the regulations "sunset" in September 2027.* The NJDOE is collecting the input through a survey, and you can choose to remain anonymous.

Survey questions allow you to suggest what changes the NJDOE should make and why. For example, you may think that specific regulations need to be clarified, or staff need training, or particular supports are missing to accomplish the regulation's objective. At the end of each question, a participant may include a comment as to how the existing law could be improved or changed. 

Surveys must be submitted to the NJDOE by August 30, 2025. Please speak up and help ensure an equitable, effective, and responsive special education system that meets the needs of the students and families that it serves.

*Sunset: A sunset provision is a part of some laws that allow for the termination of the law on a certain date unless further legislative steps are taken to continue the law. Sunset dates provide an opportunity for state agencies like the Department of Education to make changes to current laws. 

Doulas: A Vital Part of Perinatal Care

Posted on August 4, 2025

winifred headshot
Winifred Smith-Jenkins
Director of Early Childhood Policy and Advocacy

Doulas are trained professionals who provide emotional, physical, and informational support during pregnancy, childbirth, postpartum care, and in the event of loss. Unlike medical providers, doulas offer continuous, personalized non-clinical care that focuses on comfort, advocacy, and helping families navigate the birthing process. Their presence is proven to improve birth outcomes and reduce disparities, particularly for Black and Brown birthing people who face some of the highest maternal mortality rates in the country.

Why Doulas Matter

Doulas aren’t a luxury. They’re a life-saving support system. Research has shown that doula supported births:

Doulas help close racial and economic gaps in maternal health, and they do it while centering the needs of families.

2025 election badge2

Let's make children and their
families the center of the
2025 Election Campaign.

The Need for Community-Based Doulas Is Rising, but Where Are They?

While more doulas are being trained, many are leaving the profession due to inadequate compensation structures.  

      • Most doulas work without benefits, steady income, or adequate reimbursement for time spent providing related services.
      • Doulas serving low-income and Medicaid clients often cut their fees significantly; sometimes earning less than $500 for months of care.
      • Many offer sliding scale or free services, leading to burnout, financial instability, and a shrinking workforce.

If we want to keep doulas in the field, we must pay them a living wage.

Medicaid: A Critical Opportunity

Medicaid covers nearly 42% of U.S. births, making it a powerful lever for increasing access to doula care. Several states including New Jersey, Oregon, California, Illinois, and New York  have added doulas to Medicaid, but challenges remain:

      • Reimbursement rates vary widely and are often too low to support a full-time salary.
      • Credentialing requirements sometimes exclude experienced community-based doulas.
      • Bureaucratic barriers make it hard for doulas to enroll as Medicaid providers.

What Needs to Change

To ensure doulas can thrive and families can access their support, Medicaid coverage must follow best practice standards including:

      • Providing fair, equitable and sustainable compensation by setting reimbursement rates that reflect the full scope of care;
      • Allowing experience-based and community-informed credentialing pathways;
      • Eliminating unnecessary red tape to make enrollment and billing as a Medicaid doula provider simple and accessible; and
      • Including doulas in program design, oversight, and quality monitoring

The Bottom Line

We cannot achieve better birth outcomes; or true maternal health equity, without investing in doulas. That means moving beyond pilot programs and charity models to sustainable public funding, especially through Medicaid. If doulas are essential--and they are--we must treat them like it, by paying them fairly.

This Election Year: Ask the Candidates:

  1. What will you do to ensure that all families in New Jersey; especially Black and Brown communities, have access to community-based doulas through Medicaid?
  2. Do you support raising Medicaid reimbursement rates so doulas can earn a living wage for the critical care they provide?
  3. How will you make sure experienced doulas are included in decisions about state policy and funding for maternal health?

Food for Thought: The Real Costs of Restricting SNAP Benefits

Posted on July 24, 2025

Screenshot
Authored by:
Adriana Bland
Deborah T. Poritz Summer Public Interest Legal Fellowship Program, LSNJ

For more information on positive youth development efforts, contact Isaiah Fudge at Ifudge@acnj.org.

On July 4, Trump signed into law what was known as the “Big Beautiful Bill” (HR1). Despite its name, this legislation endangers people’s ability to live safely and comfortably. The bill makes significant changes to the Supplemental Nutrition Assistance Program (SNAP), restricting eligibility and imposing greater administrative costs on the states, with a goal of reducing federal spending by nearly $300 billion.

These changes will have profound consequences on SNAP, which is the largest food safety net program in the United States. In New Jersey specifically, over 800,000 individuals rely on SNAP benefits to put food on the table, with over 40% of recipients being children.

Beginning in the 1930s, states created county welfare boards that were responsible for administering public benefits to residents. New Jersey is one of ten states where programs are still administered at the county level. The counties not only serve the residents, they also employ them. As a result, counties pay a portion of the administrative costs, and state and federal dollars cover the costs of benefits. While benefit dollars help to stimulate the local economy, a county’s administrative cost is a very small percentage of the actual benefits that return to the community.

Until HR1 was signed into law on July 4, states and the federal government shared a 50/50 split on SNAP administrative costs. HR1 makes the states responsible for 75% of the administrative costs and 5% of the actual benefit paid to each SNAP recipient. The New Jersey Department of Human Services estimates that the state budget needs to raise $100-$300 million to implement these new cost-sharing requirement changes, or risk eliminating the entire SNAP program for New Jersey. County governments will need to come up with an additional $78 million for their portion of the administrative costs. This increase in the state's financial responsibility will further decrease resources and access to SNAP benefits, and cause serious strain to the program that helps to ensure that thousands meet one of their most basic needs.  

Those currently receiving SNAP benefits are not exempt from the direct impacts of HR1. Changes to household eligibility and work requirements may force people to lose SNAP benefits entirely.

Current SNAP recipients between the ages of 18 and 54 who do not reside with a child under 18, and who are able to work are classified as Able-Bodied Adults Without Dependents (ABAWD) and are subject to time limits and work rules. Individuals subject to the ABAWD Time Limit Rules can only receive SNAP benefits for three months in a three-year period unless they are working, volunteering, or in an allowable activity for at least 80 hours a month.

While ABAWD Time Limit Rules have always existed, SNAP recipients haven’t always been subject to their strict enforcement. Prior to HR1, Time Limit Waivers for areas with high unemployment, as well as discretionary exemptions, helped relieve some recipients from ABAWD rules–especially in the aftermath of COVID-19. As HR1 is implemented, these waivers will no longer be available.

Under HR1, work reporting requirements will be expanded to include ABAWD up to age 65 and include parents or guardians of children over the age of 14. Additionally, veterans, the homeless, and young people aging out of foster care are no longer exempt from the work requirement. 

Rest assured that changes to SNAP will not be felt overnight, but families will begin to feel the impact as HR1 is implemented, and it's important that they remain informed.

Big Medicaid Changes Coming Following Trump’s July 4th Budget Bill

Posted on July 24, 2025

Mary profile photo
Mary Coogan
President/CEO

Many continue to analyze the potential impact of the One Big Beautiful Bill Act that President Trump signed on July 4 (hereinafter referred to as HR1). HR1 provisions impacting New Jersey's Medicaid population were shared at the NJ Medicaid Assistance Advisory Council (MAAC) meeting on July 17. Materials from this and other MAAC meetings are available on the MAAC website

It is not yet clear what adjustments New Jersey may need to make to NJ FamilyCare or state benefits as the new requirements are implemented, with some changes taking effect immediately and others over the next few years. Please read the statement from NJ Department of Human Services Commissioner Sarah Adelman to appreciate the breadth of changes to HR1 makes to Medicaid.

Here is what we know about changes to federal Medicaid funding
A primary goal of HR1 is to save $800 billion over the next 10 years in federal Medicaid spending. These savings will be achieved by imposing additional requirements to enroll or maintain coverage, which will likely result in recipients of health coverage through state public health insurance programs, such as NJ FamilyCare, losing their coverage. Reducing the number of New Jersey citizens enrolled will, in turn, decrease the amount the federal government pays to states to support public health insurance programs and other Medicaid-funded services. 

Every state has a public health insurance program, such as NJ FamilyCare, funded with state and federal Medicaid and Children's Health Insurance Program (CHIP) dollars. Currently, nearly 20% of New Jersey residents, including over 860,000 children, access healthcare through NJ FamilyCare, and almost 550,000 working-age adults are enrolled through the Affordable Care Act's Medicaid expansion. This Medicaid expansion population is the focus of many of the new federal requirements. 

Federal Medicaid matching payments to states for qualified medical services are based on the Federal Medical Assistance Percentage (FMAP). The FMAP varies by state and is computed from a formula that takes into account the average per capita income for each state relative to the national average. New Jersey is one of 10 states that benefits from the current law, which sets a minimum federal match level at 50%. Specific categories of health insurance have different levels of FMAP. CHIP receives a 65% federal match, and the Medicaid expansion population gets a 90% federal match. According to the New Jersey Department of Human Services, "the federal government assumes ~60 percent ('blended share') of the cost of NJ FamilyCare":  

      • 90% of the cost for low-income adults covered under the Affordable Care Act
      • 65% of the cost for moderate- to low-income children under CHIP
      • 50% of the cost for most other NJ FamilyCare members

NEW Medicaid Work Requirements and Eligibility Redeterminations
The law requires states to condition Medicaid eligibility for individuals ages 19 to 64 in the Medicaid expansion population on working or participating in qualifying activities, such as education or volunteer services, for at least 80 hours per month. Certain adults, including pregnant or postpartum members, former foster youth up to age 26, parents with children age 13 and under, and those who are "medically frail," are exempt from the requirement. If a person is denied or disenrolled from NJ FamilyCare for failing to meet their work requirements, they are also ineligible for subsidized Marketplace coverage.

Under the new law, NJ FamilyCare renewal determinations for most of the adults enrolled through Medicaid expansion scheduled on or after December 31, 2026, must be conducted every six months. Thus, most of these adults will need to prove they meet the work or community engagement requirement twice a year. This change will result in an additional workload for state and county workers who handle eligibility determinations. States demonstrating a good faith effort to comply and making progress may have until December 31, 2028, to fully implement the change. 

The New Jersey Department of Human Services estimates that up to 300,000 eligible residents may lose, or fail to obtain, NJ FamilyCare coverage due to new bureaucratic barriers, many of which stem from the difficulty in producing the required documentation. Up to 50,000 adults could lose coverage because they are unable to provide the necessary documentation to comply with the work requirement. This may result in $400 million in lost federal funding to New Jersey.  

Out-of-Pocket Costs Imposed on all Medicaid Enrollees
All states currently have the option to impose out-of-pocket costs such as premiums and copayments on some Medicaid enrollees. As of October 2028, states must charge Medicaid enrollees with family incomes between 100% and 138% of the federal poverty level (FPL)–which is $15,650 for a single adult who qualifies for the program based on income alone–up to $35 per healthcare service. Certain services and providers are exempt from this cost-sharing obligation, including prenatal care, pediatric care, primary care, emergency care, and care delivered by federally qualified health centers or certified community behavioral health clinics that provide mental health care or substance use disorder services. The cost-sharing will be capped at 5% of a family's household income.

Under current law, undocumented immigrants are not eligible for Medicaid coverage. Several states, including New Jersey, use state-only funds to provide health coverage to children, regardless of immigration status–as long as the household income meets the eligibility requirements. Initial budget reconciliation proposals sought to reduce the federal Medicaid match for these states. The Senate parliamentarian ruled that this provision cannot be enacted as part of the budget reconciliation process. However, as of October 1, 2026, in the adult population, only lawful residents, Cuban/Haitian entrants, and Compact of Free Association migrants from certain Pacific Island nations will qualify for Medicaid. Approximately 15,000 to 25,000 individuals in New Jersey will lose Medicaid coverage. 

Provider Taxes
Currently, the state assesses a tax on hospitals, providers, and health plans of up to 6% of revenue, which is eligible for a federal match. New Jersey then reinvests these funds into our healthcare system. For fiscal year 2026, this assessment is projected to generate approximately $875 million in federal revenue. HR1 requires that, starting in fiscal year 2027, the cap of 6% be gradually reduced to 3.5% by fiscal year 2032. Nearly $400 million will be lost as a result of this reduction. Fourteen counties utilize the provider tax to secure additional federal funding for their hospitals. The state estimates that by 2032, approximately $800 million of this federal revenue will be lost.

Emergency Medicaid
Emergency Medicaid offers limited coverage for individuals who lack a qualifying immigration status and covers emergency services delivered in an inpatient hospital setting. New Jersey's federal match starting in October 2026 will be reduced from the current 90% match to the 50% base rate. New Jersey is likely to lose in the range of $446 million in annual federal Medicaid funding.

Clearly, HR1 will have a devastating impact on NJ FamilyCare, hospitals throughout the state, and other Medicaid-funded programs. These cuts may also impact school-based, health-related services and possibly behavioral health services provided through our state’s Children’s System of Care. 

ACNJ is working with other organizations that serve those enrolled in NJ FamilyCare to help educate members about new requirements, and with state officials to ensure compliance as these requirements are implemented. For more information, contact Mary Coogan at mcoogan@acnj.org