New Jersey's top health officials went to the Statehouse on Thursday with a number: $3.7 billion. That's how much federal health care money the state stands to lose every year by the end of the decade because of the Medicaid changes in the law Trump signed in July 2025, they told the state Senate's health committee, according to the New Jersey Monitor.
Every Republican who represents New Jersey in the U.S. House voted for that law — twice. Chris Smith, Tom Kean Jr. and Jeff Van Drew voted yes when the House passed its version 215 to 214 in May 2025, a margin so thin any one of them could have stopped it. They voted yes again when the House passed the final version on July 3, 2025.
What New Jersey is about to lose
Medicaid in New Jersey is called NJ Family Care, and it covers 1.8 million residents. Here's what state officials said the budget bill does to it:
- Up to $3.7 billion a year in lost federal funding by the end of the decade, much of it from cuts to state-directed money for hospitals and doctors.
- Up to 330,000 people pushed off their current health plans, which Human Services Commissioner Stephen Cha said could cut payments to New Jersey doctors and hospitals by another $2 billion to $3 billion a year.
- At least 165,000 more adults uninsured and at least $1.8 billion a year in losses — and that's Cha's office's estimate even if the state succeeds in limiting the damage.
"Behind every number is a person: someone who needs a checkup, a parent managing a chronic condition," Cha told legislators.
January: paperwork or lose your coverage
The biggest change hits in January. Starting then, 540,000 low-income adults on NJ Family Care will have to send in documents proving they work, volunteer or go to school at least 20 hours a week — or lose their benefits. They'll also have to re-enroll every six months instead of once a year.
There are limited exemptions for people who are disabled or too sick to work. New Jersey and other states are challenging those rules in court.
Cha said his department is working with counties, insurers and community groups to help people get through the extra paperwork. Even so, his office's best-case estimate is still 165,000 more uninsured adults.
Hospitals feel it too
The lost federal money means cuts to state-run programs that fund hospital outpatient services, which New Jersey has relied on heavily in recent years, the Monitor reported. And when fewer people have insurance, hospitals and doctors get paid less for treating them. Even if it doesn't show up in the state budget, Cha said, the cuts will hit health care in New Jersey.
"It's not going to show up as a $1.3 billion to $3 billion deficit, but it's $1.3 billion to $3 billion less from the federal government," Cha said.
New Jersey "cannot fully offset every federal reduction," he told the committee.
The timing isn't an accident
Trump said the Medicaid changes were meant to cut what the federal government spends. But the biggest cuts were scheduled to kick in after this November's election. We've laid out how Republicans scheduled the pain for after you vote — the January work requirements are one example.
This is the second time in a month the three of them have had to answer for this law in New Jersey. In September, state officials warned that refugees and trafficking victims in New Jersey could start losing Medicaid under the same bill — and Van Drew had signed a letter in April 2025 saying he "cannot and will not support" a bill that cut Medicaid coverage for vulnerable people.
The bottom line
New Jersey officials say Trump's budget bill will cost the state up to $3.7 billion a year in federal health care money, push up to 330,000 people off their health plans and leave at least 165,000 more adults uninsured even in the best case. Starting in January, 540,000 low-income adults must prove they work 20 hours a week to keep their coverage. Chris Smith, Tom Kean Jr. and Jeff Van Drew — New Jersey's three House Republicans — voted for the law in May and again in July 2025, when the first House vote passed by a single vote.
