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Newly eligible for Medicaid in Missouri? Lawmaker wants you to work for your health care

Jeanne Kuang, The Kansas City Star on

Published in News & Features

JEFFERSON CITY, Mo. — Republican lawmakers are again seeking to restrict the Medicaid expansion voters approved in 2020, proposing work requirements for the estimated 275,000 low-income Missourians newly eligible for the health care program.

A constitutional amendment filed in the General Assembly this week by House Budget Chair Cody Smith would make funding for that group of recipients subject to annual review, separating them from overall support for the traditional Medicaid program.

It is the latest attempt by Missouri Republicans to curb the expansion of the program to working adults without children after defeats at the ballot box and in court.

Voters approved a constitutional amendment expanding Medicaid with 53% of the vote in August 2020, after years of refusals by the Legislature.

Most states have expanded eligibility through a provision of the Affordable Care Act, which allows those earning up to 138% of the federal poverty level to receive Medicaid. In 2021, that was just under $17,800 for a single adult and $36,570 for a family of four. Previously, Missouri allowed few nondisabled adults onto the program; parents were eligible only if they made about $5,830 for a family of four.

Republicans refused to put money in the budget last year for the new recipients. It led Gov. Mike Parson to halt expansion until the state Supreme Court unanimously ruled the state must allow eligible Missourians to enroll. Parson's administration last year estimated expansion would cost $130 million in state funds and come with $1.6 billion from the federal government.


By expanding, the state also receives about $1 billion in incentive funds from the Biden administration, as part of the American Rescue Plan.

As of last week, 53,151 have enrolled in the expanded program since October. The Department of Social Services has about 69,000 applications pending, officials told the House Budget Committee on Monday.

Under the court order, the state is required to enroll new recipients regardless of the funding lawmakers approve for Missouri's Medicaid program, known as MO HealthNet. Without additional money the entire program has only enough cash to operate through mid-February, budget director Dan Haug said.

The money to make up the difference is included in an emergency supplemental budget bill that also includes pay raises for state workers and allocates federal aid dollars. Funds for expansion would be coming not out of general revenue, but federal COVID-19 relief money that lawmakers set aside previously.


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