Missouri House passes bill to curb Medicaid expansion, add work requirements

Missouri House Republicans have not given up their quest to unravel the expansion of Medicaid that voters approved in 2020, passing a bill Thursday to institute work requirements and give lawmakers the power to decide from year to year whether to cover the new recipients.

The passage came just an hour after the General Assembly finally sent Gov. Mike Parson a budget bill that funds the expansion through the rest of the fiscal year that ends in July. About 66,500 low-income Missourians are on the program after the expansion went forward under court order last fall, and the state faces a backlog of over 70,000 pending applications.

Republicans in Missouri have repeatedly resisted expansion of the health program, which is 90% federally funded, to working adults without children. The state last year estimated 275,000 Missourians who make up to 130% of the federal poverty level, or $36,075 for a family of four, would qualify.

The proposed constitutional amendment that passed the House by a 95-45 vote Thursday would make funding for that group of recipients subject to annual review, separating them from overall support for the traditional Medicaid program. In effect, it allows lawmakers to approve or deny coverage to them in any given year.

It also would require enrollees to work, participate in job training or job searching, or obtain an exemption in order to receive Medicaid. Missouri already has work requirements for welfare and food stamps programs.

And it would end a unique payment system in which Missouri subsidizes some care for out-of-state Medicaid patients at in-state hospitals. The subsidies particularly benefit children’s hospitals in Kansas City and St. Louis, which draw patients from the Midwest region.

It now goes to the Senate, and if approved would be placed on the ballot this fall for a statewide vote.

Work requirements for Medicaid were encouraged by former President Donald Trump’s administration, which approved the rules for a dozen states. The Biden White House has been rescinding those permissions.

House Budget Chair Cody Smith, a Carthage Republican and the measure’s sponsor, said it would “allow us to uncouple parts of the Medicaid program and prioritize them through the appropriations process, in the event we need to.”

Smith has repeatedly raised concerns about the ongoing costs of the expansion, though Missouri currently enjoys record revenues. It is receiving about $2.7 billion in federal funds from the Rescue Plan. The state ended the fiscal year last July with a $1 billion surplus and expects to do the same this year.

Democrats slammed the proposal and said they were confident it would be defeated at the ballot box.

“Here we are again trying to undo the will of the people,” said Rep. Maggie Nurrenbern, a Kansas City Democrat.

Medicaid expansion went into effect late last year, after the General Assembly blocked funds for the new population of enrollees. In a subsequent ruling, the Missouri Supreme Court said Parson’s administration could not deny the coverage despite the funding decision, because the eligibility expansion had been voted into the state constitution.

Republicans have bristled, arguing they should continue to get the say.

“If we don’t respond to this and reclaim for ourselves, allow the people to reclaim for themselves the power of their elected representatives to have the power of the purse, I would ask… why would anyone want to serve on the budget committee?” said Rep. Dirk Deaton, a Noel Republican. “If we don’t have the power of the purse, we don’t have anything.”