Missouri’s Republican legislative leaders used their last few hours before spring break to make it known they are not on board with raising the state’s miserly income qualifications for Medicaid.

“We do not believe it’s prudent to double down on a broken system,” said Tom Dempsey, the Republican Senate president pro tem.

Medicaid actually works very efficiently for a lot of people, but that’s their story and they’re sticking with it.

This doesn’t necessarily mean Republicans won’t ultimately expand Medicaid eligibility. Virtually every business group in the state wants them to do so, and Democrats are already sharpening their knives for the campaign season two years hence.

Refusal to insure very low-income Missourians has cost Republicans at the polls before, and a recent survey indicates it may do so again.

The challenge for Republicans is to expand Medicaid eligibility without looking as though they are complying with Obamacare, which still is derided in the capitol with a disgust befitting toxic sludge in state waterways.

Also, Republicans must avoid handing a victory to Democratic Gov. Jay Nixon, who is campaigning feverishly on behalf of enabling poor people to see a doctor.

There are ways to pull off this delicate dance. Other GOP-dominated states have done it.

For all the griping in state capitols about the tyrannical federal government, the U.S. Department of Health and Human Services has given states remarkable leeway in deciding how to insure low-income citizens.

The Affordable Care Act, passed by Congress three years ago, called for states to expand their Medicaid eligibility limits to 133 percent of the federal poverty level, about $30,000 for a family of four. But the U.S. Supreme Court made the expansion optional.

States have plenty of reasons to expand their limits. The federal government will pay the full cost of the expansion the first three years, and never less than 90 percent. Also, expanding Medicaid will keep hospitals solvent, as Washington is sticking to its intention to phase out payments for serving uninsured patients.

Instead of simply huffing about overbearing federal laws, as Missouri Republicans are prone to do, savvier GOP-dominated state legislatures are using the Affordable Care Act as an opportunity to make their Medicaid programs more, well, Republican.

Some states have obtained waivers to move all Medicaid recipients into managed care. Others are insisting on deductibles and incentives to avoid wasteful care. Arkansas recently secured permission for the most radical departure yet — it will use federal money to cover the premiums on private insurance plans for new recipients.

Ideas such as these are being kicked around in the Missouri legislature, and several intrepid Republican House members have even folded some of them into a bill. But midway through the session, nothing has gelled.

It doesn’t help that GOP leaders insist on operating on false premises.

In a statement last week, leaders of the Missouri Senate falsely asserted that expanding Medicaid eligibility from Missouri’s miserly threshold of 19 percent of the poverty level would cost the state nearly $1.2 billion through 2022. It is a preliminary number from a national research group that doesn’t consider the huge economic gains that would come from expanding the state’s health care network at the federal government’s expense, or offsetting savings in the state budget.

A much more comprehensive analysis by Nixon’s budget department has calculated that Missouri would actually reap nearly $600 million in additional revenues through 2022 by expanding Medicaid. If Republicans don’t agree with the governor’s math, they should commission an honest study of their own.

“I personally do not view health care as a right,” House Speaker Tim Jones told reporters last week.

That’s unfortunate. But even coming from that perspective, a responsible leader should recognize that widespread access to health care is good public policy. Other red states are finding ways to achieve that goal. Missouri must decide quickly which it wants to be: leader or laggard.