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Missouri House advances bill to undercut Medicaid expansion

A sign urges lawmakers to fund Medicaid expansion at a rally in support of the program at the Capitol in Jefferson City on April 27, 2021.
Sebastián Martínez Valdivia
A sign urges lawmakers to fund Medicaid expansion at a rally in support of the program at the Capitol in Jefferson City on April 27, 2021.

The Missouri House advanced a bill Tuesday that would put Medicaid expansion back on the ballot. The bill proposes a constitutional amendment that, if approved, would give lawmakers the power to refuse to fund the Medicaid expansion group.

Under Medicaid expansion, Missourians making less than $17,700 a year can receive coverage. Since the program started in October, following a Missouri Supreme Court decision, 64,210 Missourians have successfully enrolled. That number represents less than a quarter of those estimated to be eligible.

Rep. Cody Smith, R-Carthage, is the chairman of the House Budget committee who sponsored the bill. Smith led the effort to strip funding for Medicaid expansion from the state budget last spring.

On the house floor Tuesday, Smith explained the amendment would allow legislators to split funding for Medicaid expansion recipients off from the broader program. “This would enable us to kind of uncouple those two parts of the program and appropriate for them independently, and respectively of each other,” Smith said.

Democrats argued their Republican colleagues have made their intentions with Medicaid expansion clear. Rep. Betsy Fogle, D-Springfield, said she was frustrated to be relitigating the issue. “We've had this debate, we've had this conversation, it has been settled by the courts," Fogle said. "I'm very disappointed that we're back up here in 2022, having the same conversation about who in the state of Missouri should get Medicaid and who shouldn't win, this has already been decided.”

The constitutional amendment would also add a work and residency requirement to the program. Smith spent most of his time on the House floor Tuesday speaking on those two measures, arguing Missouri is footing the bill to care for non-residents on Medicaid. "We're in a situation where Missouri taxpayers are subsidizing the Medicaid programs of folks that live in other states," Smith said. "And that's not to say that they don't need treatment in Missouri, but their respective Medicaid programs can pay for that."

The work requirements would apply to Medicaid recipients between 19 and 64 years of age, and would mandate 80 hours of work per month. Researchers have found work requirements for social services in other states have been associated with decreases in enrollment, but not corresponding increases in employment.

The bill will now advance to a third reading. If approved, the constitutional amendment would appear on the ballot in November's mid-term elections.

Sebastián Martínez Valdivia is a health reporter and documentary filmmaker who focuses on access to care in rural and immigrant communities. A native Spanish speaker and lifelong Missouri resident, Sebastián is interested in the often overlooked and under-covered world of immigrant life in the rural midwest. He has a bachelor's degree in broadcast journalism from the University of Missouri and a master's degree in documentary journalism at the same institution. Aside from public health, his other interests include conservation, climate change and ecology.