Stephen Cha, MD, Commissioner of the New Jersey Department of Human Services

As Commissioner, you must be preparing New Jersey for the federal cuts and requirements of H.R.1 (the “One Big Beautiful Bill”). What progress has been made so far — and what do you envision for the work ahead?

This may feel theoretical for some, but we need to face the reality of the impact in New Jersey. As many as 350,000 people may lose Medicaid coverage — billions of dollars lost, beginning as soon as October. There are also billions more in cuts to hospitals and health systems, ramping up through 2030.  People will still need health care, so that’s billions shifted from the federal government to New Jersey taxpayers, and I’m not seeing the level of urgency we need. I want to make people understand that all this is approaching. This is real.

Our focus for the next few months in Medicaid is eligibility and enrollment. The number of people cut from Medicaid will depend on how well our systems work — and whether people can get through new bureaucratic red tape to access coverage they’re eligible for.

It’s also about SNAP food benefits.  As many as 50,000 may lose SNAP benefits due to federal changes.  And the federal government is also shifting costs to counties. Without any real policy goal, they are shifting almost $100 million in SNAP administrative costs every year to counties and the state.

Governor Sherrill’s budget tackles the challenges of HR1. It includes $71 million mostly for counties to account for the SNAP administrative cost shift and also includes $10.5 million to support partnerships with other state agencies, counties, and vendors to prepare for the changes in Medicaid.

How do you envision New Jersey residents being impacted?

There’s been a lot of talk about the work requirements — which will be a paperwork burden even though most people will remain legally eligible. But there is also the six-month Medicaid redetermination. Folks are going to have to find and update their paperwork and resubmit it every six months. It’s mind-boggling how this will work out. I mean, can you imagine re-applying for health benefits every six months? And folks may show up to get care and be confused. ‘What do you mean I don’t have coverage? How am I no longer eligible for the care I came here to get?’ That could play out at an FQHC, a hospital emergency room, or wherever.

The Quality Institute, supported by our more than 120 member organizations, convened the H.R.1 Health Care Access Workgroup, which developed recommendations to address the impact of these federal changes. How do you see the Quality Institute and other New Jersey organizations supporting your efforts moving forward?

I appreciate the breadth of representation on the Workgroup. I appreciate the work to create evidence-informed strategies, and especially the way the lessons draw from past experiences and strengths — such as the unwinding. Many of the Workgroup recommendations align with the work streams we are engaged in right now.

We all need to face this together. We need partnerships and trusted messengers. There are some people who are going to tune in to every message we send out from Human Services. And then there are people — and this is probably most people — who won’t  do that. We need to reach everyone. A lot of the folks on your workgroup have different channels to talk to people, different ways of reaching people — and we need to patch into every channel and work to get that 350,000 number down.

And we need to have a conversation about system transformation as those cuts from H.R.1 ramp up. I keep telling folks that we’re in a giant ship heading toward a hurricane. Sure, that hurricane might dissipate if Congress saves us all. But I’m definitely not counting on that. So here’s the question: How can we transform our systems here in New Jersey to serve real people with less support from the federal government? I keep telling people, H.R.1 was not our choice, but how we move forward here in New Jersey is our choice.

Your background includes experience at the Centers for Medicare & Medicaid Services, at a major managed care organization, and providing direct patient care at a federally qualified health center in Washington, D.C. What attracted you to public service in New Jersey?

For me, it’s about making policy and complex systems work for real people. In Washington, I was sometimes far removed from that impact. But on Tuesday nights, as a primary care physician at a homeless shelter site for an FQHC, I saw firsthand how policies affect people.

In New Jersey, I can bring those perspectives together — to make systems work better for people here. My early conversations with the governor and her team were also key. They are committed to making government responsive and improving affordability — and that shows in how they work every day.

How will your previous experience inform your new role?

It’s about bringing large, siloed organizations together to solve real problems.

And it’s about listening to real people. During the infant formula shortage, we had a massive operation — coordinating shipments, changing regulations, speaking with CEOs. But I also stayed in touch with one mother whose child had an illness and needed a specific formula. Even when all the CEOs were saying everything was fine, I checked in with her all the time. It’s not enough to make policy changes or hold press conferences.  We have to improve the lives of real people.

We like to end with a question beyond your professional role. If you had to choose, who would be your real-life hero?

To me, it’s the nameless, faceless bureaucrats and public servants who find ways to make these systems work better. I’m thinking of people who have literally made the lives of millions of people better … and who have never gotten a fancy New York Times story written about them. I am awed by their commitment and sacrifice.

I am literally thinking of a couple people in particular who have done such amazing work to improve our programs — across Democratic and Republican administrations alike — just continuing to try to move our programs forward and make them work better for everyone. It’s a privilege to have seen it, and I wish the public could see it as well.