Medicaid Cuts, Forced Treatment…The Resurgent War on the Poor & What’s Coming for NJ’s Vulnerable
-John Migueis
I’ve lived in New Jersey my whole life, and I’ve come to see this state as one strange neighborhood—a dysfunctional family, but still a family. With all it’s defects, I wouldn’t want to be anywhere else. I love NJ, I love saying I’m from NJ and I feel really fortunate to be able to raise my kids here.
Historically, we’ve been a left-leaning republican-ish state with a moderate approach to social issues. But that middle ground is being tested. The ideological polarization in Washington is trickling down and threatening programs that New Jerseyans—not just the poor, but working and middle-class families too—depend on every day.
Let’s start with Medicaid.
It was Republican Governor Christie Whitman who launched New Jersey’s Children’s System of Care. It used Medicaid dollars to expand behavioral health services for families who couldn’t afford to go private. The goal was simple: make mental health care more accessible, keep families involved, and reduce the unnecessary institutionalization of kids who were being placed out of home not because of clinical need—but because they were poor. It wasn’t perfect, but it worked. This is important to note, since NJ has historically been on the losing end of federal contributions.
Now, all of that is at risk.
HR 1 (’One Big Beautiful Bill Act’) just signed in D.C. slashes federal Medicaid support—cutting provider taxes and reducing the federal match for states. That’s going to hit our behavioral health infrastructure hard. Families who currently get care for free or at reduced cost will suddenly find themselves priced out or dropped entirely.
New Jersey will have to either increase state funding or make cuts. And the people who will feel it first? Children with autism or complex behavioral needs who rely on intensive case management. Foster youth. Kinship caregivers. Adoptees. School-based therapy services—speech, OT, mental health—could be slashed across districts.
The bill also imposes quarterly eligibility checks and 80-hour-per-month work requirements for adults. Some folks may defend this as a form of accountability but how is this accomplished by punishing children for their parents’ inability—or even just failure—to meet bureaucratic standards. And increased copays (up to $35 per service) might sound manageable to some, but for families juggling multiple weekly appointments in today’s economy, it’s back-breaking.
The end result? Higher costs, worse outcomes.
When community services disappear, we fall back on institutional care which is more expensive and less effective. When people can’t afford preventive care or therapy, they wait until the worst happens then show up in emergency rooms, where treatment is costlier and outcomes are poorer.
And then came the Executive Order.
Signed on July 24, 2025, President Trump’s “Ending Crime and Disorder on America’s Streets” reads like something pulled from the 1950s. It calls for mass institutionalization, criminalization of homelessness, and dismantling of harm reduction strategies that have saved lives. It isn’t just regressive—it’s a complete rejection of liberty and self-determination, ideals the Republican Party once claimed to champion.
This is what the Executive Order lays out-
Encourages states to involuntarily institutionalize individuals with mental illness or addiction who are deemed unable to care for themselves.
Prioritizes federal funding for cities and states that enforce bans on urban camping, squatting, and loitering.
Authorizes forced treatment of the homeless via civil commitment.
Defunds harm reduction (needle exchanges,safe injection sites).
Allows federally funded housing providers to collect and share health data with law enforcement
Makes housing assistance conditional on mental health or addiction treatment.
And while NJ does not have to comply with the Executive Order, not doing so may lead to loss of funding tied to homelessness, behavioral health, or housing programs.
It’s not just bad policy. It’s a wild departure from reason.
It’s an expensive, punitive approach that channels money into police salaries, prison systems,and institutions while gutting liberty, privacy, and civil liberties.
Does this sound like the party of Reagan or Goldwater?
Is it really more fiscally responsible to incarcerate and institutionalize than to invest in health centers, housing, basic needs, and voluntary care?
Things are confusing right now. Jobs are harder to find, our money is losing value and our state and local governments are taking more money and becoming less transparent. It feels almost impossible to make ends meet while saving for college and the anger over income disparities and it’s connection to political influence is both reasonable and palpable.
The temptation to trade in our civil liberties and sound approaches to complex problems for federal dollars is strong – but it will only cost us more in the long run with the costs transcending dollars and cents.
References:
Congress.gov – H.R. 1 (One Big Beautiful Bill Act) full bill text and summary
https://www.congress.gov/bill/119th-congress/house-bill/1
Families USA – Section-by-section summary of Medicaid-related changes in the 2025 budget bill
https://familiesusa.org/wp-content/uploads/2025/07/Families-USA_-Senate-Passed-BBBA-Provisions-Related-to-Medicaid-ACA-and-Medicare_UPDATED-7.1.25.pdf
NJ Spotlight News – Bracing for Medicaid Cuts in NJ
https://www.njspotlightnews.org/video/bracing-for-medicaid-cuts-in-nj/
New Jersey Monitor – Medicaid cuts could hurt older adults who rely on home care, nursing homes
https://newjerseymonitor.com/2025/03/30/medicaid-cuts-could-hurt-older-adults-who-rely-on-home-care-nursing-homes/
KFF – The potential effects of Medicaid work requirements on coverage
https://www.kff.org/medicaid/issue-brief/the-potential-effects-of-medicaid-work-requirements/
NJ Children’s System of Care – NJ Department of Children and Families
https://www.nj.gov/dcf/about/divisions/dcsc/
Medicaid and CHIP – MACPAC
https://www.macpac.gov/wp-content/uploads/2025/06/MACPAC_June-2025-WEB-508.pdf
Rockefeller Institute – New Jersey’s net federal contribution ranking
https://rockinst.org/issue-areas/fiscal-analysis/federal-budget/federal-funding-and-new-jersey/
White House – Executive Order: Ending Crime and Disorder on America’s Streets (July 24, 2025)
https://www.whitehouse.gov/presidential-actions/2025/07/ending-crime-and-disorder-on-americas-streets/
Reuters – Trump orders crackdown on homeless encampments nationwide
https://www.reuters.com/world/us/trump-orders-crackdown-homeless-encampments-nationwide-2025-07-25/
Axios – What to know about Trump’s civil commitment plan
https://www.axios.com/2025/07/25/civil-commitment-trumps-homelessness-policy
The Guardian – Trump order pushes cities to clear the unhoused
https://www.theguardian.com/us-news/2025/jul/24/trump-homelessness-executive-order
National Homelessness Law Center – Response to Executive Order
https://homelesslaw.org/resources/executive-order-response
The views expressed in this editorial are solely those of the author and do not necessarily reflect the views of other NJ21st editors or contributors.
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A few thoughts ;Last week I sat on the edge of my property with a lovely young woman dress in ripped clothes ,sitting in the dirt her back back ,looking hungry hot and tired . She was clearly severely mentally ill , speaking incoherently about conspiracy , being on a mission from special forces , not having parents a spiritual conception ect. I gave her a sandwich and sat and chatted . I am trained in working with individuals with neurological issues but could not get any information from her to assist. She had clear symptoms of Psychosis & little coherent conversation was possible . I called the county police hoping they could provide a resource to assist , They referred me to Mountainside . We called Mountainside police and requested they not scare her , she committed no crime we just wanted help for her. . They took a long time to arrive then approached chatted with her did nothing told her to go . This vulnerable young woman was left on the streets to wander on a 100 degree day as many like her are . This is on Mountainside It is easy for people in elite neighborhoods to feign compassion . You don’t live among the un-housed . Defecation & urinating on the street , crime , unsanitary unsafe tent communities that encourage and facilitate crime ,alcohol and drug use. Your children unable to walk to school or utilize the parks due to unsafe , unhealthy conditions for those that live their and others . The shelters are horrendous dangerous and many un-housed people I have spoken to feel safer on the street . Using government dollars to fund injection sites is horrific in my opinion that’s not compassion that’s assisted suicide. Food stamps 1/3 of the people collecting are able bodied without children able to work . You rob people of dignity with entitlements .Again personal responsibility not addressing the root and just providing housing is ineffective waste of lives,resources and time. Housing assistance should be contingent on mental health addiction treatment. No one will pay your mortgage if you choose to drink or do drugs all day and not seek meaningful employment why would it be any different for unhoused populations. Those in high crime cities of New Jersey are grateful for increased police presence and policies that make their communities livable . Medicaid discussion thoughts , Many of the medicaid cuts are directed at the massive fraud .”The bill protects and strengthens Medicaid for those who rely on it—pregnant women, children, seniors, people with disabilities, and low-income families—while eliminating waste, fraud, and abuse. The One Big Beautiful Bill removes illegal aliens, enforces work requirements, and protects Medicaid for the truly vulnerable.” Side note many parents who seek services for their children with autism or learning issues have to battle for them in a district with some very expensive per student costs, Governor Livingston .Clearly ,money doesn’t result in quality of services & healthy communities good leadership is desperately needed in New Jersey .