About

Joel Cantor, Sc.D., is a Distinguished Professor of Public Policy and the founding Director of the Center for State Health Policy at Rutgers University in New Brunswick, New Jersey. Established in 1999, the Center is a leader in health policy research and development nationally, with a special focus on informing policy in New Jersey. Dr. Cantor is widely published in the health services and policy literature, particularly on innovations in health service delivery and the regulation of private health insurance markets. He serves as an advisor on health policy matters to the New Jersey state government and received the Rutgers University President's Award for Research in Service to New Jersey in 2006. Prior to joining Rutgers, he served as director of research at the United Hospital Fund of New York and director of evaluation research at the Robert Wood Johnson Foundation. He earned his doctorate in health policy and management from Johns Hopkins University in 1988 and was elected a Fellow of AcademyHealth in 1996. His research interests include health care financing and delivery, health care policy, and access to health services by low-income populations.

Research topics

• Medicine
• Internal medicine
• Family medicine
• Political Science
• Psychology
• Nursing
• Law
• Gerontology
• Emergency medicine

Selected publications

• Emergence and Potential of State Healthcare Cost Growth Benchmark Programs

  Journal of Health Politics Policy and Law · 2026-03-20

  articleOpen access1st authorCorresponding

  Healthcare cost benchmark programs have emerged as states seek to curb healthcare cost growth. States feel the adverse effects of rising healthcare expenditures acutely through Medicaid, employee health benefit programs, and the growing burden of benefit costs on private sector employers. Beginning with Massachusetts in 2013, eight states have established benchmarks through executive action or legislation. These programs set cost-growth benchmarks and collect data to compare spending trends to the benchmarks at multiple levels, from statewide performance to individual providers and insurers. Many states employ a graduated strategy to promote compliance with benchmarks, ranging from public reporting of provider and insurer performance to imposing sanctions for persistent growth above targets. The effectiveness of these initiatives is not yet clear, in part because most programs are relatively new and early trends were obscured by the pandemic. Several factors suggest that benchmark programs may ultimately achieve meaningful, sustainable impact, including mounting cost pressures, broad support for transparency, and phased enforcement approaches. However, entrenched interests, the need for ongoing investment in program infrastructure, and the inherent complexity of healthcare cost containment present significant challenges.

  PublisherOA PDFDOI

• Structured adult learning outside school or job associates with improved plasma markers of age

  medRxiv · 2026-01-13

  articleOpen accessSenior author

  BACKGROUND: Peak educational attainment is linked to early life general cognitive abilities, mid-life socioeconomic status, and late-life dementia risks. Yet, it is difficult to study its mechanisms acting across decades of life given diverse paths towards peak attainment and lifelong learning opportunities. METHODS: We analyzed profiles of peak educational attainment, adult learning (formal, job-related, non-formal, informal), and their relationships to novel plasma proteomic markers of age in a regionally representative cohort of 580 adults. RESULTS: One in three participants obtained their highest degrees beyond first three decades of life, with differential associations with parental education and personality traits. Similar associations were observed for job-related, non-formal (structured learning outside of school or job), and self-directed informal learning. Only non-formal learning correlated with a protective profile of plasma proteins reflecting age-associated vascular dysfunction and arthritis. CONCLUSION: Non-formal adult learning may improve plasma age markers and should be further investigated.

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• Breast, Cervical, and Colorectal Cancer Screening Among New Jersey Medicaid Enrollees: 2017-2022

  JCO Clinical Cancer Informatics · 2025-08-05

  article

  PURPOSE: The COVID-19 pandemic disrupted cancer screenings in the United States, with disproportionate impact on health disparity populations. The objective of this study was to examine the impact of the pandemic on routine screening for breast, cervical, and colorectal cancer among Medicaid enrollees. MATERIALS AND METHODS: This study is a retrospective, descriptive analysis to estimate the rate of breast, colorectal, and cervical cancer screenings among Medicaid enrollees age 50-75 years in New Jersey. Secondary enrollment and claims from the 2017-2022 Medicaid Management Information System were used. The results were stratified by screening type and socioeconomic factors. Bivariate analysis assessed between-group differences. RESULTS: Although April 2020 had the lowest screening rates in the 6-year period, rates for all three cancer types rebounded to prepandemic levels by late summer 2020. In 2022, breast cancer screening rates exceeded previous peaks. However, cervical and colorectal screening rates did not resume their prepandemic trajectories. Key findings comparing 2022 with 2019 were (1) across all three cancer screening groups, the younger group (50-64 years) had a higher screening rate than the older group (65-75 years); (2) Hispanic enrollees consistently had the highest screening rates; (3) the screening rate among dually eligible enrollees increased throughout the pandemic; and (4) there was wide screening variation by geographic region. CONCLUSION: Multilevel, multisectoral approaches, including policy and health system strategies, are critical to addressing gaps in care for Medicaid enrollees. Future efforts should focus on bolstering cervical and colorectal cancer screening rates and ensuring equitable access to cancer screening and treatment.

  PublisherDOI

• Providing Health Care to People Experiencing Homelessness: Strategies and Challenges for Cross‐Sector Initiatives

  Milbank Quarterly · 2025-09-15 · 1 citations

  articleOpen accessSenior author

  Policy Points Initiatives that effectively bridge health care and housing sectors in serving people experiencing homelessness (PEH) shared four dimensions: success in matching client preferences with readily achievable options, maintaining intensive interaction, initiating outreach where clients are, and co-locating health and housing services. Analyses of accounts of those with firsthand experience implementing cross-sector programs yielded valuable guidance on strategies for incorporating these dimensions. Changes in policies associated with the new federal administration may pose new challenges but are unlikely to alter the relevance of accumulated experience in making use of available resources to effectively engage PEH in health care and housing services. CONTEXT: Cross-sector collaborations among health care and housing services organizations promise more efficient use of resources and delivery of more coherent and effective services to people experiencing homelessness (PEH). This study analyzes challenges and strategies reported by those currently implementing cross-sector programs. METHODS: Data were collected through in-depth interviews with staff of health care and housing services at eight programs systematically selected to typify the scope and nature of cross-sector collaborations in New Jersey. Respondents included administrators (n = 14) and frontline providers (n = 10). Questions focused on motivations to collaborate, approaches to sustaining partnerships and managing operations, mechanisms for financing services across sectors, and strategies for effectively engaging PEH in health care services. Interviews were audio-recorded and inductively analyzed using standard qualitative techniques. FINDINGS: Collaborations were motivated by the impact of housing on health, the ineffectiveness and costs of attempting to address unmet health care needs in the absence of providing shelter, and the promise of harnessing resources from both sectors. Accounts of successful approaches for engaging PEH in health care services had four fundamentals in common: establishing rapport through matching client preferences with readily achievable options, maintaining intensive interaction, initiating outreach where clients are, and co-locating health and housing services. Favored policies for promoting effective implementation included financing case management services through contract or capitation arrangements, resolving ambiguities in licensing regulations and reimbursement practices that impede co-location of services, securing direct financing for delivery of nursing services at shelters, and providing greater support for frontline providers. CONCLUSIONS: The programs' accumulated experiences in successfully implementing cross-sector programs yielded valuable insights for other organizations seeking to mount similar initiatives and for creating a more hospitable policy environment for programs to succeed. Policies of the new federal administration may raise new challenges but are unlikely to diminish the importance of lessons for achieving effective cross-sector collaboration.

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• Health implications of established and emerging stressors: design of the prospective New Jersey Population Health Cohort (NJHealth) Study

  BMJ Open · 2025-03-01

  articleOpen access1st authorCorresponding

  INTRODUCTION: Some stressors, like the death of a partner, are common and rigorously studied, while others, such as those related to climate change or social media, are just emerging and in need of systematic research. The New Jersey Population Health Cohort (NJHealth) Study aims to characterise established and emerging stressors and delineate the pathways through which they influence health, especially among groups likely to experience chronic exposure to stressors including immigrants, people of colour, multigenerational families and low-income families. METHODS AND ANALYSIS: A prospective cohort, the NJHealth Study is recruiting 8000 NJ residents aged 14 and older using probabilistic and purposive methods to include members of multigenerational families, marginalised racial/ethnic and low-income populations, and recent immigrant groups. Building on ecosocial, life course and stress process models, the NJHealth Study employs multimodal data collection to comprehensively measure stress-related factors at individual and societal levels. Interviews include self-assessments of individual and societal stressors, potential stress buffers and amplifiers, and health and well-being outcomes, including cognitive function, activity limitations and self-reported health. In addition, salivary DNA, fasting plasma, health assessments and actigraphy data are collected from selected participants; and existing electronic health records, health insurance claims, social service and employment data, and vital records are linked. NJ's socioeconomic and demographic diversity make it an exceptional setting for the study. Strong community and stakeholder engagement supports effective translation of research findings into practical policy and programme applications. ETHICS AND DISSEMINATION: The study was approved by the WCGIRB (Study #1321099) (formerly Western IRB). Informed consent is obtained from participants for each source of participant-level data as well as linked administrative and clinical records. Findings will be reported to study participants, funding bodies, governmental and policy stakeholders, presented at scientific meetings and submitted for peer-review publication.

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• Erratum: Breast, Cervical, and Colorectal Cancer Screening Among New Jersey Medicaid Enrollees: 2017-2022

  JCO Clinical Cancer Informatics · 2025-09-01

  article
  PublisherDOI

• Physician explanation of Z-coded homelessness in medicaid claims

  Health Services and Outcomes Research Methodology · 2025-09-15

  articleOpen accessSenior author

  Abstract The International Classification of Diseases, 10th Revision (ICD-10) introduced a set of social determinants of health (SDOH) codes including Z59.0, indicating homelessness. Z codes are not widely used, and it is not clear how Z59.0 is used to document homelessness. The goal of this study was to examine patterns of Z59.0 within a linked administrative data set and explore physician explanations for coding prevalence. This study used sequential explanatory mixed methods, first examining claims data from New Jersey Medicaid linked to Homeless Management Information System (HMIS) data for adults aged 18 and older in 19 in 21 counties from 2014 to 2016 ( n = 724,463). The rate and patterns of Z59.0 coding was compared to HMIS-recorded homeless service use. Then we conducted semi-structured interviews with 18 physicians at high-coding hospitals analyzed via thematic analysis. Only 1.1% of inpatient and ED claims were Z-coded. Claims for male individuals who were age 43–59, Non-Hispanic/White, enrolled via Medicaid expansion, of higher health burden, in the inpatient setting, or chronically homeless were more frequently Z-coded; this was consistent with physician expectations. Physicians were surprised by the frequency Z-coding of claims for individuals who were Non-Hispanic/White and could not give clear explanations as to why some hospitals had higher Z code prevalence. They suggested that individuals who had a Z code without known homeless service use were experiencing homelessness. This study suggests Z-coding for homelessness identifies individuals not using formal homeless services and may be useful to support provider efforts to address housing as a health-related social need.

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• Classification of Homelessness in Medicaid Claims and Homeless Services Administrative Records: Application of a Concordance Analysis Framework

  AJPM Focus · 2025-04-27 · 1 citations

  articleOpen accessSenior author

  Introduction: People experiencing homelessness have high healthcare utilization, with multiple indicators used to identify them in medical data. The association between the claims-based ICD-10 Z code for homelessness (Z59.0) and documented homelessness service use history is unknown. This study examined (1) Z59.0 code prevalence, (2) patterns of Z59.0 coding compared with that of known homeless service use, and (3) factors associated with Z59.0 coding. Methods: The authors used Medicaid claims linked with homelessness service use recorded in the Homeless Management Information System for 19 New Jersey counties. The outcome of interest was the prevalence of Z59.0 coding on Medicaid inpatient or emergency department claims from 2016. A concordance framework was applied to assess the alignment between Z-coded status and documented homelessness service use. Binary logistic regression models identified predictors of Z-code-based homelessness status. Results: Lower-bound estimates of sensitivity, positive predictive value, and Kappa statistic suggested weak agreement between homelessness classification within Medicaid claims and administrative records of homeless services. Homeless service use histories were significantly associated with higher odds of being Z59.0 coded. Male sex, being aged >60 years, and Medicaid expansion eligibility were all associated with higher odds of being Z59.0 coded. Substance use disorders and serious mental illnesses had the strongest associations with the presence of a Z59.0 code. Wide variation in the use of Z codes across hospitals was evident. Conclusions: Estimates suggest limited agreement in the classification of homelessness between Z59.0-coded claims status and known homelessness service utilization. The lack of systematic use of Z codes for homelessness observed by this study limits their usefulness to document health outcomes for people experiencing homelessness.

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• Frequent seizure and epilepsy‐related emergency department visits in the United States: A retrospective cohort study

  Epilepsia · 2025-07-05 · 2 citations

  articleOpen access

  OBJECTIVES: Health disparities impact access to epilepsy care in the United States, but how these factors contribute to recurrent emergency department (ED) visits is unclear. We hypothesized that people who (1) were uninsured or had public health insurance, (2) belonged to minoritized racial/ethnic groups, or (3) resided in low-income zip codes were more likely to have frequent ED visits for seizure or epilepsy. METHODS: This was a retrospective cohort study of adult patients presenting to the ED in four U.S. states (Florida, Maryland, New York, and Wisconsin) with a primary diagnosis of seizure or epilepsy. We tracked ED visits for each patient longitudinally between 2016 and 2018. We performed a multivariable logistic regression analysis evaluating the association of the above factors with a high (>2) vs low (1-2) number of ED visits. RESULTS: We identified 200 962 patients who visited the ED for seizure/epilepsy, of whom 28 598 (14.7%) presented >2 times during the study period. Compared to private insurance, individuals with Medicare (adjusted odds ratio [aOR] 1.90, 95% confidence interval [CI]: 1.82-1.99), Medicaid (aOR 2.01, 95% CI: 1.93-2.09), or no insurance (aOR 1.55, 95% CI: 1.48-1.62) had increased odds of high ED visits. Black patients had a 60% higher odds of frequent ED visits compared with White patients (aOR 1.60, 95% CI: 1.55-1.65). However, these disparities were attenuated for Black patients with Medicare and Medicaid, vs private insurance. High ED use was not seen in other racial/ethnic groups. Finally, patients living in low-income zip codes (0-25th percentile of median household income; aOR 1.65, 95% CI: 1.58-1.73) were more likely to be in the high ED visit group, compared with the highest income quartile. SIGNIFICANCE: Racial/ethnic and socioeconomic inequities likely contribute to frequent ED visits for seizures, as evidenced by our findings from four U.S. states. Effective, multi-level interventions are needed to reduce disparities for those most affected.

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• Longitudinal Associations From US State/Local Police and Social Service Expenditures to Suicides and Police‐Perpetrated Killings Between Black and White Residents

  Milbank Quarterly · 2025-05-29

  articleOpen access

  Policy Points Despite documented inequities in suicide trends and police-perpetrated killing for Black compared with White Americans, government expenditures have not been examined as upstream drivers of these inequities. This longitudinal study found police expenditures predicted increases in suicide and police-perpetrated killings for Black, but not White, residents. Housing and community development expenditures were associated with decreases in suicide for Black residents only, and kindergarten through 12th grade (K-12) education expenditures were associated with decreases in suicide for White residents only. Findings suggest reducing police, and increasing housing, expenditures may reduce Black-White inequities in suicide and police-perpetrated killing. CONTEXT: Despite documented inequities in suicide trends and police-perpetrated killing for Black US Americans, there is little research investigating how structural factors like government expenditures may drive these outcomes. This study examined associations from police and social services expenditures to later suicides and police-perpetrated killings for Black and White residents. METHODS: This longitudinal study analyzed 2010-2020 US Census of Governments-tracked state and local government expenditures and Centers for Disease Control and Prevention (CDC)-tracked years of potential life lost (YPLL) to suicide and police-perpetrated killing. Dynamic structural equation models estimated 1- and 5-year lagged associations. Models adjusted for reverse associations (i.e., violent death to later expenditures) and state-level variables including Medicaid expansion, Black-White population, racial residential segregation, political representation, overall expenditures, state firearm policies, and firearm violence rates. FINDINGS: For suicide, every $100 increase in per capita police expenditures was associated with 35 more YPLL 1 year later (γ = 0.35, 95% credible interval [CI] 0.02-0.90) and 28 more YPLL 5 years later (γ = 0.28, 95% CI 0.001-0.55) per 100,000 Black residents. For police-perpetrated killings, every $100 increase in per capita police expenditures was associated with 7 more YPLL 1 year later (γ = 0.07, 95% CI 0.02-0.12) per 100,000 Black residents. As such, a $100 per capita increase in annual police expendiutres translated to 14,385 more YPLL to suicide, and 2,877 more YPLL to police-pepetrated killing, 1 year later for the United States' 41.1 million Black residents. There were no associations between police expenditures and outcomes for White residents. Conversely, every $100 increase in per capita housing and community development expenditures was associated with 29 fewer YPLL to suicide 5 years later per 100,000 Black residents (γ = -0.29, 95% CI -0.53 to -0.05). Every $100 increase in per capita kindergarten through 12th grade (K-12) education expenditures was associated with 4 fewer YPLL to suicide 1 year later per 100,000 White residents (γ = -0.04, 95% CI -0.07 to -0.01). CONCLUSIONS: Consistent with CDC recommendations to promote housing stability as suicide prevention, reducing police expenditures and increasing housing expenditures may decrease Black-White inequities in YPLL to suicide and police-perpetrated killing.

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Recent grants

• NIH Grant R24HS019678

  NIH · $984k · 2013

• NIH Grant R01HS014191

  NIH · $944k · 2008

Frequent coauthors

• Derek DeLia

  Rutgers, The State University of New Jersey

  47 shared

• Jennifer Tsui

  University of Southern California

  21 shared

• Margaret Koller

  Rutgers Sexual and Reproductive Health and Rights

  17 shared

• Alan C. Monheit

  Rutgers, The State University of New Jersey

  16 shared

• Donald R. Hoover

  Rutgers, The State University of New Jersey

  13 shared

• Michael Steinberg

  12 shared

• C. Golden

  12 shared

• José Luis Muñoz de Nova

  Hospital Universitario de La Princesa

  12 shared

Awards & honors

• Rutgers University President's Award for Research in Service…
• Fellow of AcademyHealth (1996)