How an Urbanized State Revamped Its Rules for Health and Social Service Programs

During 1997 to 1998, researchers at the Urban Institute examined the state of New Jersey as part of a multi-year study called Assessing the New Federalism.

The institute's study was designed to analyze the devolution of responsibility for social programs from the federal government to the states, focusing primarily on health care, income security, job training and social services.

The study included case studies, surveys and data collection that created a publicly available database focused on New Jersey.

The Washington-based Urban Institute is a nonprofit, nonpartisan organization that conducts research on social and economic issues.

Key Findings

  • Health policy issues have not had a high profile since an integrated set of reforms was passed in 1992.

  • The state's top health priority is the Medicaid program, which claims 24 percent of New Jersey's budget (including the federal contribution).

  • Competition among hospitals and the entry of managed care into the state have both been slow to develop.

  • Long-term care and other services for the elderly were moved into the Department of Health (renamed the Department of Health and Senior Services in 1996), a shift likely to raise the clout of senior citizens on budgetary and programmatic matters, including long-term care.

  • The Department of Health and Senior Services has four major public health policy concerns:

    • Maintaining federal support.
    • Continuing long-term efforts to promote regionalization as a way to improve the quality and efficiency of local public health services.
    • The impact and opportunities of the move to managed care.
    • The impact on public health of being joined by senior services.