A Senate committee version of the legislation would ask voters to authorize the state to impose work requirements, but it wouldn’t require them if federal law changes
BY: Steph Quinn
Missouri Independent
A proposal to write Medicaid work requirements into the Missouri Constitution has been stripped down in a Senate committee to instead give lawmakers, the governor or the state’s social services department constitutional authority to impose them.
Starting Jan. 1, 2027, the One Big Beautiful Bill Act passed by Congress will require new eligibility checks on adults covered through Medicaid expansion — the Affordable Care Act provision that allowed states to offer coverage to more low-income adults. States will have to verify that enrollees ages 19 to 64 are working, volunteering or attending school for at least 80 hours a month to get or keep coverage. They also will have to check eligibility twice a year instead of annually.
The original legislation, which passed the House last month, would have enshrined those work requirements in the state constitution even if the federal law changes. The amended Senate version would give the state power to impose the requirements but would not mandate them or restrict how the state might implement them in the future.
The Senate version is similar to legislation sponsored by Republican state Sen. Jill Carter of Granby, who is the chair of the committee that approved it last week.
Dennis Rhodes, Carter’s chief of staff, told The Independent that the changes are intended to clear the way for the lawmakers to impose Medicaid work requirements in state law if they are no longer federally mandated. Voters would need to approve the changes before they become law.
“Currently,” Rhodes said, “we can’t do work requirements.”
The Missouri Constitution prohibits “greater or additional burdens or restrictions on eligibility standards” for people who qualify for coverage under expanded Medicaid coverage, which was passed by the state’s voters in 2021. The updated proposal would add an exception for work requirements.
To qualify for coverage in the expansion population, a single Missourian working full-time can earn no more than $10.59 per hour, or $22,024 annually, while the combined earnings of a family of four can’t exceed $21.89 per hour, or $45,540 per year. That’s about 30% less than the state’s minimum wage of $15 an hour.
A constitutional amendment, Rhodes said, is “not like a bill, where if you missed something here or there, you can tweak it easily. …This gives the [legislature] or the state the authority to make the requested changes on the statute level without having to go back and worry about passing a Constitutional amendment.”
Republican state Rep. Darin Chappell of Rogersville, who sponsored the proposed amendment, told The Independent he hopes some of his original legislation can be added back into the bill.
He’d like to restore a ban on self-declaration of exemptions from work requirements, and prohibit the department from granting optional hardship exemptions without the legislature authorizing it in state law.
“I still don’t think we ought to be offering waivers without legislative authority behind that,” Chappell said.
Chappell has argued that savings from his proposal could help safeguard state services for vulnerable Missourians as the state faces budget headwinds. He referred to Gov. Mike Kehoe’s proposed $80.7 million in cuts, which have since been mostly restored, to programs that help people with developmental disabilities live safely in their homes.
“I will not let $1 be wasted on someone who’s capable and will not work, [and] be taken from those folks,” Chappell said.
About two-thirds of Missouri Medicaid recipients already work full- or part-time, according to an analysis from Washington University in St. Louis. Most people who were not working reported attending school, being retired or having a disability, illness or caregiving responsibilities that prevented them from being employed. Only about 12% of Medicaid recipients in the state reported none of those reasons for not working.
Lobbyists for cancer patients, older adults, people with disabilities and rural Missourians urged lawmakers earlier this month to reject or amend Chappell’s proposal, arguing it could lead Missourians to needlessly lose coverage and make it more difficult for the department to comply with federal law.
Missouri could face a clawback of up to $1.2 billion in federal funding if the state doesn’t decrease its Medicaid error rate below 3% by October 2029, state Social Services Director Jess Bax told lawmakers in January. Bax said the state’s error rate was 35% in 2019, the year of the last federal audit before laxer requirements during the COVID-19 pandemic.
The changes to Chappell’s proposal have quieted concerns from some advocates that it would bar the department from granting optional exemptions, including to caregivers and people who were recently hospitalized, without new state laws.
Jay Hardenbrook, advocacy director at AARP Missouri, told The Independent the department is planning for a caregiver exemption while it awaits federal guidance from the U.S. Centers for Medicare and Medicaid, which is expected this summer.
“They are gathering the data sources they need to be able to do that,” Hardenbrook said. “…Our major concern with the original language in [the legislation] is that it would basically short-circuit that process.”
During the Senate committee hearing on the bill, Jane Drummond, senior vice president of government relations for the Missouri Hospital Association, said Carter’s proposal “achieves the same thing much more simply.”
“I am concerned that the more we touch in the Constitution, the more it opens it up to issues of construction, interpretation, ambiguity,” Drummond said.
Drummond told The Independent the recent changes addressed her concerns.
Jamie Blair, an organizer at the Missouri Rural Crisis Center, testified during the Senate committee hearing that work reporting requirements will disproportionately impact rural Missourians, who are more likely to be enrolled in Medicaid, and rural hospitals.
While the latest version of the bill is “less severe,” Blair told The Independent, “adding any work reporting requirements will result in eligible people losing benefits to the administrative burden.”
Twelve rural hospitals have closed in Missouri since 2014, according to a report from the Missouri Department of Health and Senior Services.
The bill still faces opposition from Senate Democrats.
Democratic state Sen. Maggie Nurrenbern of Kansas City told The Independent that she is “committed to standing up to ensure that we do not pass this.”
Nurrenbern pointed to the cost of implementing work requirements, saying the funds could instead be used to provide healthcare to Missourians.
The budget passed by the Senate last week would allocate $53.9 million of general revenue out of a total $356.5 million in state and federal funding to implement the One Big Beautiful Bill Act in fiscal year 2027, according to documents from Senate Appropriations staff.
“It sets a really horrible precedent that we are spending hundreds of millions of Missouri taxpayers’ dollars on more bureaucracy,” Nurrenbern said, “instead of providing direct care for vulnerable people and fundamental services like access to life-saving care.”
Chappell said he hopes there’s a way forward for his proposal.
“It’s late in the session,” he said. “I suspect we’ll be dealing with this next year as well, but we’ll see.”
