While NJ is the fifth smallest state in land area in the United States (7,354 square miles), the state houses over 9.2 million residents, making it the most densely populated state in the nation, and ranking it as 11th most populous overall (Figure 2.)  Furthermore, NJ is the only state in which every one of its 21 counties is deemed “urban” by the US Census Bureau (U.S. Census Bureau, retrieved 1/16/25).  Moreover, the state boasts the privilege of housing residents from different countries and cultures.  In addition to this rich demographic population comes a geographical difference, with different regions experiencing various levels of density per square mile.  For example, the central and northern counties of NJ are very densely populated; especially the counties that are situated in the mid-north and north-east of the state and are closer to New York City.  The most northwestern counties, and the southern and northwestern counties are more rural and agricultural, and where transportation, healthcare and educational services are not as frequently, or proximally, available to residents.

 

Figure 2. NJ’s Geographic Land Area and Total Population

Data from: U.S. Census Bureau, 2025

 

In 2023, NJ's (NJ) population density--- persons per square mile, was 1,263.2 to 1. NJ is comprised of 564 municipalities and 21 counties. As of 2023, the most populated counties are Bergen and Middlesex, each with a population of 957,736 and 863,623, respectively. Bergen is also one of the top 5 most densely populated counties in the state at 4,114.2 persons per square mile (Figure 3). The most densely populated county in NJ is Hudson, with a population density of 15,272.1 to 1 (Figure 3). Hudson County has a total population of 705,472.

Figure 3. 2023 Population Density: NJ Counties

 

 

 

 

 

According to the 2023 NJ Population Estimates of race, 52.0% of the population were White, non-Hispanic; 13.0% were Black; 10.4% were Asian; 0.2% were American Indian and Alaska Native; and 1.7% reported two or more races. In terms of ethnicity, 22.7% of the population was Hispanic. The 2023 American Community Survey (ACS) estimates identified that 33.3% of NJ residents (5 years and older) speak a language other than English compared to 22.5% nationally, and which include Spanish, Polish, Italian, Bengali, Mandarin/Cantonese and Haitian.  Approximately 24% of all NJ residents are foreign-born persons, which is considerably higher than the national average, which has recently hit an all-time high of 16%.  A similar pattern is seen among women of child bearing age.

Unemployment and Uninsured Rates

Unemployment rates are impacted by market factors (ex. GDP, inflation) and individual and social factors (health, race, educational attainment).  Unemployment rates in NJ have been variable over the course of the past five years, although rural areas of the state experience higher rates of unemployment than the more suburban, peri-urban and urban locations in the state (Figure 4). Like other states, NJ suffered the impact of COVID-19 related restrictions and limitations, forcing many people to lose their sources of employment.  However, the overall unemployment rate has remained stable across NJ in the past year (~4.5%) and relatively coincides with the national unemployment rate (Figure 5; ~4.1% (US Bureau of Labor Statistics, 2025).

The income spectrum in NJ is quite large, with the median household income around $100,000 dollars, but with an average per capita income of $53,118. These integers demonstrate the large gap between the upper socioeconomic status populations in the State, and the lower-and-impoverished populations in the State.   Approximately 10% of all NJ residents live at or below the poverty line, which is slightly less than the national average of 11% (US Bureau of Labor Statistics, 2025).

Figure 4. NJ Unemployment Rates 2024

 

NJDOL Website: Feb 2025

 

 

 

 

 

 

 

 

 

 

 

 

Figure 5. 10-year Historical Employment Rate in NJ

 

NJDOL Website: Feb 2025

The NJDOH prioritizes the health needs of all its residents', centering in the work populations that have been systematically marginalized and oppressed.  This strength is evidenced by a strong public health infrastructure and health care delivery system whose activities are rooted in a contemporary evidence base, are trauma-informed and high quality.  The NJDOH partners with local Federally Qualified Health Centers (FQHCs), Community Based Organizations (CBOs), academic institutions such as Rutgers University and The College of New Jersey, as well as with service recipients, to create and deliver the MCH programming in the state. Moreover, to ensure service are funded appropriately, NJ commits a state match that is higher than the dollar-for-dollar match expected of Title V Block Grant funding, with approximately $70 million dollars of state funds invested in MCH services each year, above-and-beyond the ~$11.5 million Title V funds granted to the NJDOH.

Additionally, NJ has a low uninsured rate compared to that of the national average, with 3.8% of children under the age of 18 years old uninsured versus 5.1% of children under the age of 19 years old nationally uninsured.  NJ’s expansion of Medicaid has also facilitated the decrease of health access differences in the state and between populations and continues to engage in outreach and enrollment efforts to ensure the number of uninsured children continues to decrease over time.

Apart from direct healthcare access and insurance coverage, many supportive services are available to families in NJ, to address all CHF. A multimillion-dollar investment has been made across various workforces, chiefly, our allied professional workforce, to enhance their training and draw more people into the professions.  This includes funding for CHW’s from pre-conception to 365 post-partum.  Also, funding for midwifery education, to increase midwife enrollment and accommodate more midwives into the clinical fold.  Additionally, the doula workforce is growing with a larger investment in developing a workforce that specifically supports NJ FamilyCare families.

While there are numerous and growing strengths of the NJ health system, persistent gaps in health outcomes continue.  While health care services exist in all 21 counties of the state, providers are not equally distributed across the state.  Rural areas exist where providers are clinically saturated and unable to attend to the health care need of the populations surrounding them. This issue is further compounded by the fact that practitioners specializing in family health care and pediatrics are declining in recent years, with a dearth of providers available to service the needs of the state’s approximately nine million residents.  For CSHCN, specialists that are needed to attend to this population are facing challenges with the demand far exceeding the availability of services.  Further complicating this matter is the decline in the primary care workforce over the past few decades, which creates a smaller pool of practitioners for whom special child health becomes a vocation. While the differences in access to practitioners, and the dearth of providers in the state, creates a difficult landscape, NJ continues to commit its resources to the populations in greatest need. These, and other challenges are addressed by the state’s lead health agency, the NJDOH.

The NJDOH is the lead state agency providing core public health services to its residents, and whose mission it is to protect the public’s health, promote healthy communities and continue to improve the quality of healthcare in NJ.  Undergirding this mission is the vision of the department to ensure that all New Jerseyans live long, healthy lives and reach their fullest potential, which NJDOH takes as its primary responsibility.  This vision is supported by a public health infrastructure that is growing and strengthening as the state hires more health and allied health professionals.  Our leaders are dedicated public servants who are committed to supporting all residents in NJ in achieving their highest health potential, and full actualization.  Because the reach of the department is so vast, many types of essential healthcare services are rendered each year.  These targeted services include:

• Disease Prevention and Control
• Health Promotion and Education
• Emergency Preparedness
• Licensing and Regulation
• Health Data Collection and Analysis
• Health Regulation and Policy Development

The NJDOH has a long and strong history of coordinating and implementing a statewide system of services that is community-based, comprehensive and one which leverages community partnerships to enhance the work of our public health agency.  Partnerships are critical in meeting the varied needs of the state’s population. Additionally, NJ has several public health initiatives in progress, all aiming to address the CHF that impact people’s health trajectories.  These evidence-based and community driven plans work synergistically to support the shared goals of preventing illness, promoting wellness and addressing any gaps that exist between populations.

The NJDOH additionally oversees a number of advisory boards, councils and commissions, all which play a crucial role in shaping policy decisions and providing recommendations to our organization.  This list includes, but is not limited to:

 

Health Care Administration Board

The Board advises, generally, the Commissioner on issues related to health care policy and reviews and makes recommendations with respect to rules and regulations necessary to implement the Health Care Facilities Planning Act.

State Health Planning Board

The Board acts as an advisory panel to the Commissioner concerning recommendations on certificate of need applications to create certain new health care facilities or to expand existing services; holds public hearings in the service areas for certificate of need applications regarding transfer of ownership or closing of a health care facility.

Public Health Council

The Council ensures the reasonable protection of the health of the public-at-large; reviews and consults with the Commissioner regarding the regulations for the State Sanitary Code; reviews the administration of funds under the Public Health Priority Funding Act of 1977.

The Governor's Council for Medical Research and Treatment of Autism

The Governor’s Council for Medical Research and Treatment of Autism (Council) was created by State appropriation in 1999 and has been issuing research, clinical and educational enhancement grants since 2000.  The Council’s vision is to enhance the lives of individuals with ASD across their lifespans. The Mission of the Council is to advance and disseminate the understanding, treatment, and management of ASD by means of a coordinated program of biomedical research, clinical innovation, and professional training in NJ.

Maternal Care Quality Collaborative

The New Jersey Maternal Care Quality Collaborative (NJMCQC) is a advisory group that works with multiple departments and is currently residing with the New Jersey Maternal and Infant Health Innovation Authority (NJMIHIA). The NJMCQC will act as a strategic thought partner to NJMIHIA.

The work of the NJDOH is guided by a State Health Improvement Plan (henceforth referred to as the “Healthy New Jersey Initiative” or HNJ). The NJDOH aims to improve the health of all New Jerseyans through evidence-based, community participatory-research, attending to the varied and changing needs of the populations. Every ten years, the HNJ Strategic Plan includes establishing a framework for the initiative, determining topic areas to organize the project, developing goals, creating action plans, identifying new objectives, setting targets values, and implementing action plans to achieve those targets by the end of the decade.  A group of subject matter experts, community participants and organizations and members of the public participate to co-create the goals of the plan, which anchor to the four pillars of access to quality care, healthy communities, healthy families, healthy living.

The following activities are planned for 2025:

 

1) Hire a full time Healthy NJ Coordinator

2) Refine action plans as needed

3) Use quantitative state public health data as well as the qualitative information gathered for Community Conversations and to establish specific, measurable, achievable, realistic, time-bound objectives to measure success, and to be reached by 2030 for those objectives based on Healthy People guidelines.

4) Collectively, the action plans will become the next State Health Improvement Plan (2025).

Alongside the community-created initiatives borne out of the HNJ function the activities of the NurtureNJ Plan (Figure 6.).  The NurtureNJ Plan was spearheaded by our First Lady Tammy Murphy in 2019 as a statewide initiative committed to reducing maternal and infant mortality and morbidity, as well to ensuring healthcare for support for all women in the state.  NurtureNJ is a multipronged, multi-agency initiative that aims to make NJ the safest place for women to give birth and raise a child, and to eliminate any gaps in care.

 

Primary Objectives:

1) Reduce maternal and infant mortality and morbidity;

2) Ensuring no gaps exist in maternal and infant morbidity and mortality for across the state

 

Proximal Objectives:

 

1.      Ensure all women are healthy and have access to care before pregnancy.
2.      Build a safe, high-quality system of care and services for all women during prenatal, labor and delivery and postpartum care.
3.      Ensure supportive community environments and contexts during every other period of a woman’s life so that the conditions and opportunities for health are always available.

 

 

 

 

 

 

 

 

 

 

 

Figure 6. NurtureNJ Action Areas

 

Working in tandem with the HNJ Initiative and NurtureNJ initiatives is the work related to the national Healthy People 2030 goals, which identifies five key areas of CHF of which to focus: economic stability, education, social and community context, health and health care, and neighborhood and built environment. In consideration of CHF, there is a heightened need for integrating both health and non-health partners, as well as state, and external partners, in addressing infant, and maternal mortality, the opioid crisis, and other public health issues facing NJ residents.

The Title V MCH Block Grant Five-Year Needs Assessment Framework Logic Model summarizes the selected eight NPMs and aligns the impact of Evidence-Based Informed Strategy Measures (ESMs) on NPMs and National Outcome Measures (NOMs). The ESMs aim to identify NJ TVP efforts that can contribute to improved performance, relative to the selected NPMs. The Logic Model is organized with one NPM per row. The Logic Model is the key representation that summarizes the Five-Year Needs Assessment process and includes the three-tiered performance measurement system with ESMs, NPMs, and NOMs. The Logic Model represents a more integrated system created by the three-tiered performance measure framework, which ties the ESMs to the NPMs, in turn, influencing the NOMs. Considering the high rate of adverse birth and pregnancy outcomes in NJ, the NJTVP has been collaborating with community-based organizations to strategically address these adverse birth outcomes as they relate to pregnancy and birth outcomes.

 

Therefore, NJ TVP is taking a targeted approach to improving pregnancy and birth outcomes in the state by enhancing existing programs and creating new programs with an emphasis on this priority population through the CHW Workforce. TVP recognizes the importance of a statewide collaboration of existing traditional and non-traditional partners to address the CHF, which will be instrumental in moving the needle on pregnancy and birth outcomes (Figure 7).

 

Figure 7. Stakeholder Network

 

 

 

As a result, partners from the Department of Human Services (DHS), Health Systems and Providers, various academic institutions, DOH community and grassroots organizations, and the Community are strategically collaborating and using MCH block grant funds to implement culturally responsive public health interventions in NJ.

 

Children with Special Health Care Needs (CSHCN)

 

NJ's CSHCN program is known as Special Child Health Services (SCHS). Our purpose is to identify children with special health care conditions through our NBS programs, register them via our mandated reporting systems, and link them to resources and services via our county-based case management system.  In this way, our programs work with each other, other governmental agencies, the medical providers, social services, and families to ensure that the CSHCN population can access services and thrive in NJ (Figure 8). Over 50 staff persons from varying disciplines such as nursing, public health, and epidemiology work together to fulfill our mission. 

 

 

 

 

 

 

 

 

 

 

Figure 8. Special Child Health Services

 

 

 

The ability to screen and monitor certain conditions goes back to 1928, when NJ became the first state to have a BDR.  While the laws and regulations have been modified over time, our ability to surveil certain diagnoses is rooted in our public health surveillance laws.  The BDR mandates that all NJ residents’ birth through the age of five who have a congenital birth defect are registered with the DOH.  Due to the CDC’s prevalence of autism studies, a law was passed in 2007 to require all children through the age of 21 with an autism spectrum disorder to be registered.  As mandated conditions, parental consent is not required.  The SCHS staff work with all licensed health care providers and facilities about their role and responsibility in this process.  NJ also has a robust NBS program which requires birthing facilities to obtain blood-spot samples for 61 inborn metabolic and genetic disorders, conduct newborn hearing screening, and perform pulse oximetry screening before newborns leave their birthing facility.  These laws not only mandate the screening and registry programs but also protect the data from use other than their original purpose or the purpose to provide aggregate data about the health of the CSHCN population.

 

Our programs work as an integrated continuum of care and work within the larger health care system of 45 birthing hospitals, four birthing centers and community-based midwives, a system of tertiary care facilities that provide specialized pediatric care services, and over 3,000 pediatricians.  NJ also has a very robust Early Intervention Part C program that provides services to over 40,000 families per year.  Medicaid is also an important partner and provider of services to the CSHCN population.  The DCF also provides services to children under 21 with emotional and mental health care needs, substance use challenges and/or intellectual/developmental disabilities.  In terms of primary care, there are also 24 Federally Qualified Health Centers in NJ and a network of 104 local health departments that serve 565 municipalities, including cities, townships and boroughs.  While the CSHCN population is connected to our specialist communities, many of these other agencies and supports provide primary care, services, and funding.

 

Within NJ, we also have several children's hospitals and hospitals with specialized care units. These include:

• RWJ Barnabas Health Children's Health Network: New Jersey's largest academic health system, with four acute care hospitals, Children's Specialized Hospital, and over 35 community-based locations, and includes NJ's first pediatric trauma center.
• Hackensack Meridian Children's Health: Includes Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center located in the northern end of the state and K. Hovnanian Children's Hospital at Jersey Shore University Medical Center located in the southern end of the state.
• Cooper University Hospital is located in Camden across the Delaware from Philadelphia.  The have a large Pediatric Tertiary Care Center.
• The Children's Hospital at Newark Beth Israel Medical Center has a large Pediatric Tertiary Care Center.
• Rutgers Health - Robert Wood Johnson Medical School Children's Health Institute of New Jersey (CHINJ) has a Pediatric Tertiary Care Center in New Brunswick which is in the center of NJ.

 

With support from the State and Title V funds, health service grants are distributed to multiple facilities throughout NJ. Located across the state, these child evaluation and tertiary care centers serve approximately 58% of the children who are uninsured or are covered via Medicaid/Medicare programs.  These grant-funded centers leverage our funds with their other funding streams to ensure that the CSHCN population has access to important services in a timely manner.

 

Special Child Health Programs also work with their community partners and families.  We have a long relationship with the NJ Chapter of the American Academy of Pediatrics (NJAAP), family advocacy organizations such as Autism NJ, SPAN Parent Advocacy Network, and University-based programs such as the Boggs Center on Disability and Human Development. Working closely with our services are the county-based case management organizations.  Grants are provided local health departments or non-profit entities to provide free resource and referral services to all families with children with special health care needs.  These agencies work to connect families to Medicaid, provide support to families as they access medical, social, and educational services for their children.

 

NJ State Legislation and Regulations relevant to the MCH Block Grant

The following laws aimed at improving maternal health and access have been adopted by the NJ Legislature and enacted by the Office of the Governor since 2018. Nearly a dozen additional maternal health-focused bills remain under consideration, reflecting the whole-of-government focus on maternal mortality and morbidity:

• P.L.2018, c.82 – Entrusts NJDOH to develop an annual NJ Report Card of Hospital Maternity Care. The report is required to include rates of cesarean births, infection, laceration, hemorrhage, and severe maternal morbidity for all birthing hospitals.
• P.L.2019, c.75 - The original public law that created the NJ Maternal Data Center, NJ Maternal Mortality Review (MMRC) Committee, and NJ Maternal Care Quality Collaborative, later revised under P.L.2023, s.3864.
• AR2019 – Encourages NJDOH to develop set of standards for respectful care at birth and to conduct public outreach initiatives.
• P.L.2019, c.85 - Provides Medicaid coverage for doula care.
• P.L.2019, c.86 - Establishes perinatal episode of care pilot program in Medicaid.
• P.L.2019, c.87 - Prohibits health benefits coverage for certain non-medically indicated early elective deliveries under Medicaid program, State Health Benefits Plan, and School Employee Health Benefits Plan.
• P.L.2019, c.88 - Codifies current practice regarding completion of Perinatal Risk Assessment (PRA) form by certain Medicaid health care providers.
• P.L.2019, c.133 - Establishes pilot program to evaluate shared decision-making tool used by hospitals providing maternity services, and by birthing centers.
• P.L.2021, s.4229 - Establishes doula directory in DOH; requires a doula directory to receive reimbursement for doula services rendered to Medicaid beneficiary.
• P.L.2021, c.187 - Establishes a newborn home nurse visitation program (universal home visiting), supplementing various parts of statutory law, and making an appropriation.
• P.L.2021, c.79 - Requires that every hospital that provides inpatient maternity services and every birthing center licensed in NJ shall implement an evidenced-based training for all health professionals who provide perinatal treatment and care to birthing mothers at the hospital or birthing center. Members of various medical licensing boards must also complete a program related to community health factors and approved by the Department of Law and Public safety.
• P.L.2023, s.3864 - Establishes the New Jersey Maternal and Infant Health Innovation Center Authority and moves the Maternal Care Quality Collaborative to the Authority.
• P.L.2023, s.4119 - Requires hospitals and birth centers to develop doula access policies and procedures.
• P.L.2023, a.4223 - Increases Medicaid reimbursement rates for primary care services and aligns with midwifery and physician rates.
• S912/A3887 - Recently signed bill that establishes certain requirements for postpartum care, pregnancy loss, and stillbirth information and develop personalized postpartum care plans.

 

 

 

 

NJ State Legislation and Regulations relevant to the CSHCN Population

The following laws aimed at ensuring the screening and services to children with special health care needs.  These laws are amended overtime to include new services, additional mandated conditions, and/or changes in process or reporting procedures.

• P.L.1977, c.321, s.1; amended 1981, c.357, s.2; 1988, c.24, s.2; 2019, c.296, s.1.

N.J.S.A 26:2-110 through 26:2-112, as amended and supplemented - Establishes the newborn blood spot screening program

• P.L.2001, c.373, s.3

N.J.S.A. 26:2-103.3 through 26:2-103.9 as amended and supplemented – Establishes screening for hearing loss in all newborn children.

• P.L. 2021, c.413 requires all infants born in our state to be screened for congenital Cytomegalovirus (CMV).
• P.L.1983, c.291, s.2; amended 2005, c.176, s.2; 2012, c.17, s.351.

N.J.S.A 26:8-40.2 mandates reporting to the NJ BDR all children diagnosed with a birth defect from birth through five years of age. 

N.J.S.A 26:8-40.22 Confidential reports of abortions of fetus with or infant affected by birth defect or severe neonatal jaundice.

• P. L.2007, c.170, s.3; amended 2009, c.204, s.5; 2012, c.17, s.141.

N.J.S.A 8:20-2.3 mandates the reporting to the NJ Autism Registry any person, from birth through 21 years of age, who is a resident of the State of NJ and is diagnosed with autism based on DSM criteria, and who is not known to be previously registered.