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

Posted on September 2, 2025

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

Missed the event? Click here to view some highlights.

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

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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.

The Workforce Behind Every Workforce: Why Child Care Must Be New Jersey’s Next Priority

Posted on October 27, 2025

Authored by:

Winifred-Head-Shot2

Winifred Smith-Jenkins, Ed.D.
Director of Early Childhood Policy and Advocacy

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

As New Jersey stands at a pivotal moment in its economic and social history, the next governor has an unprecedented opportunity, and responsibility, to secure the foundation of the state’s future: its child care system. Few policy areas are as critical to the health of New Jersey’s economy, workforce participation, and children’s long-term success as affordable, high-quality child care.

Why Child Care Deserves the Next Governor’s Full Attention

Child care is not just another line item in the state budget. It is the invisible infrastructure that makes everything else possible. What makes child care unique, and why it must be at the top of the next governor’s agenda, is that it is deeply interconnected with nearly every other statewide priority.

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1. It’s Economic Infrastructure, Not a Private Convenience

Child care is the workforce behind every other workforce. When parents have access to reliable, affordable care, they can work, earn, and contribute to the state’s economy. When they don’t, businesses lose employees, productivity declines, and economic growth slows.

Inadequate child care costs the U.S. economy an estimated $122 billion annually in lost earnings, productivity, and revenue. Here in New Jersey, that translates into an estimated $3.6 billion economic loss each year; driven by parents missing work, employers struggling with absenteeism, and reduced tax revenues from families forced out of the labor force (First Five Years Fund, 2025; NJ Business & Industry Association, 2024).

With New Jersey losing an estimated $3.6 billion each year due to child care breakdowns, investing in affordable, reliable care isn’t just social policy. It's a sound economic strategy.

2. It Shapes Educational and Workforce Readiness for Generations

High-quality early childhood education doesn’t just help children. It strengthens the state’s long-term human capital. Children who attend quality early learning programs are more likely to succeed in school, graduate, and contribute productively as adults. Investing in early care is one of the most cost-effective strategies for building a skilled future workforce and reducing later spending on remedial education, health care, and social services.

3. It Advances Gender Equity and Family Economic Stability

The child care crisis disproportionately impacts women, especially mothers, who are often forced to reduce hours or leave the workforce entirely when child care is unavailable or unaffordable. That means lost income for families and lost talent for New Jersey employers.

But even when mothers remain employed, they face stalled career growth. A 2024 Robin Hood Foundation report found that 34% of working mothers declined a promotion or shifted to part-time work because of child care challenges (Robin Hood Foundation, 2024). These choices, often made out of necessity, limit women’s advancement and deepen gender wage gaps across industries.

Supporting the child care system is therefore an economic equity strategy, helping parents, particularly women, stay in and advance within the workforce.

4. It Strengthens Small Businesses and Local Economies

Most child care providers in New Jersey are small businesses that employ local residents, pay local taxes, and support their communities. When those programs close, it’s not just a loss for families. It’s a loss for neighborhoods and local economies. A robust child care sector sustains thousands of jobs and allows other small businesses to thrive by ensuring their employees can show up to work consistently.

5. It’s a Public Health and Community Stability Issue

Quality child care also supports children’s health and development, providing safe environments where they can receive nutritious meals, developmental screenings, and early intervention when needed. When the system is weak, children are more vulnerable to neglect, instability, and lost learning opportunities. All of which have long-term public health implications.

In short: Child care is not just another policy issue. It's the foundation that underpins nearly every other goal a governor could hope to achieve. From economic competitiveness and educational excellence to family well-being and equity, investing in child care is the single smartest, most cross-cutting decision the next governor of New Jersey can make.

The Affordability Crisis for Families

For too many New Jersey families, child care costs are simply out of reach. In some counties, the cost of infant care rivals or exceeds college tuition. A two-parent family earning the state’s median household income, about $126,000 a year, can expect to pay roughly $36,600 annually for center-based care for two young children (one infant and one preschooler). That means nearly 30% of their total income would go toward child care; over four times the federal affordability benchmark of 7%.

For a family earning less than the median, the percentage is even higher, forcing parents to make impossible choices between paying for care, saving for the future, or covering essentials like housing and health care. Affordable child care isn’t a “nice-to-have.” It’s the infrastructure that makes all other work possible. Without it, entire industries suffer, and families lose stability.

(Sources: First Five Years Fund, Child Care Aware of America, U.S. Department of Health & Human Services)

The Unsustainable Reality for Providers

At the same time, the child care providers who sustain this essential system are struggling to stay open. The child care industry is among the most heavily regulated sectors in New Jersey, and for good reason. These regulations are designed to protect the health, safety, and well-being of children, ensuring appropriate ratios of adults to children, staff training requirements, background checks, and facility standards that meet strict licensing criteria.

But compliance comes at a cost. Providers must maintain low child-to-staff ratios, employ qualified teachers, and meet facility, health, and insurance requirements. All while balancing increasing costs for rent, food, utilities, and supplies. These are labor-intensive businesses, meaning wages and benefits make up the largest portion of expenses. Yet, despite the level of skill, training, and responsibility required, many educators earn barely above minimum wage; far less than peers in other professions requiring comparable qualifications.

And even as programs struggle to meet state safety standards, they are being squeezed by skyrocketing insurance premiums. Many insurance carriers have begun pulling out of the child care market altogether, viewing it as “too high-risk.” Those that remain are charging astronomical rates, in some cases doubling or tripling premiums in a single year. A trend documented by multiple national reports (Bipartisan Policy Center, 2024; New America, 2024; Fast Company, 2024).

For small, community-based providers, especially family child care homes, these rising costs can mean the difference between staying open or closing their doors.

This is not a result of poor business practices. It’s a market failure. One that arises because the true cost of providing high-quality, safe, and developmentally appropriate care far exceeds what most families can afford to pay. The math simply doesn’t work: if providers raise tuition to cover actual costs, families are priced out. If they keep tuition lower to stay accessible, programs can’t pay teachers a living wage, or keep up with ballooning insurance costs.

Expecting families, already stretched to their breaking point, to shoulder higher costs is not the solution. The only sustainable way forward is through public investment. The kind of bold, systemic commitment that treats child care as essential infrastructure, just like roads, schools, and public transit.

Why Now Is the Moment for Action

The window to act is closing. The temporary federal relief funds that kept child care programs afloat during the pandemic have expired, and New Jersey’s system is already showing signs of strain. Across the country, programs are closing, educators are leaving, and families are feeling the squeeze, and New Jersey cannot afford to be next.

The warning signs are clear and urgent:

  • The child care workforce in New Jersey remains substantially below its pre-pandemic levels, even as other industries have fully recovered (Rutgers School of Management and Labor Relations, 2024). 
  • The average advertised wage for child care teachers is just $17.68 an hour,barely half the state’s average hourly wage, making it nearly impossible to attract and retain qualified staff (Heldrich Center for Workforce Development, 2025). 
  • In Middlesex County, there are roughly 37,000 children under age six with working parents but only 13,500 licensed child care slots, meaning only about 36% of the need is being met (Rutgers PolicyLab, 2024). 
  • New Jersey’s total licensed child care capacity dropped by over 25% during the pandemic and has yet to fully rebound (Rutgers PolicyLab, 2021). 
  • And most recently, the New Jersey Child Care Assistance Program (CCAP), a lifeline for working families, stopped accepting new applications as of August 1, 2025 because available funding ran out. When state support runs dry, low- and moderate-income parents lose access to the very care that allows them to stay employed.

These facts make one thing clear: the system is already cracking. Programs are closing, teachers are leaving, and families are being turned away. Without bold and immediate public investment, New Jersey risks losing more of its child care infrastructure; and with it, the stability of its workforce and economy.

Delaying action doesn’t mean standing still. It means falling behind. The next governor will inherit a system at a tipping point. Choosing to invest now means building a stable, affordable, and equitable child care system that supports families, employers, and educators alike. Waiting means allowing it to collapse under its own weight, and paying far more to rebuild it later.

A Call to Lead with Courage

New Jersey has long been a national leader in education and innovation. The next governor has the chance to extend that legacy by treating child care as the public good it truly is. That means committing to sustainable public funding, investing in fair compensation for educators, and creating a system that ensures access to affordable, high-quality care for every family; no matter their income or zip code.

Investing in child care is not just the smart move, or the right move. It's the only way forward to secure a thriving, equitable future for New Jersey's children, families, and economy. 

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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