Missouri GOP continues fight to limit access to Medicaid

JEFFERSON CITY, Mo. -- Missouri's GOP-led House on Tuesday advanced a proposal to allow lawmakers to defund Medicaid expansion, which would effectively undo voters' recent decision to increase access to the government health care program.

The measure, which received initial House approval in a voice vote, would give lawmakers the power to stop paying for health care coverage for the patients recently added to the program.

"That could be very important in future years when and if potentially Medicaid becomes prohibitively expensive that it continues to encroach on other priorities in our state budget," House Budget Chairman Cody Smith said during a House floor debate.

If approved by the full Legislature, the proposed constitutional amendment would go before voters.

Missouri Republicans for years have resisted attempts to expand Medicaid under the terms of the 2010 federal health care law signed by former President Barack Obama. So advocates in Missouri bypassed the Legislature and in 2020 went directly to voters who approved a constitutional amendment expanding access to the program with 53% of the vote.

Previously, Missouri's health care program did not cover most adults without children, and its income eligibility threshold for parents was one of the lowest in the nation, at about one-fifth of the poverty level.

Even after voters approved Medicaid expansion, GOP lawmakers have continued to fight it.

Legislators last year refused to front the money needed to pay for health care for the newly eligible population in hopes of blocking the program's expansion. A judge ruled in August that Republican Gov. Mike Parson's administration must implement the program anyway, and lawmakers have since budgeted for the program's expansion.

Lawmakers are now seeking to amend the Missouri Constitution once again to ensure they have the leeway to refuse funding for the expanded program.

"It really is quite shocking that we continue to turn our back on the voters of Missouri and continue to turn our back on health care," Kansas City Democrat Rep. Patty Lewis said.

The amendment also would require recipients to fulfill work requirements, with some exceptions.

Under the proposal, Medicaid recipients older than 19 and younger than 65 would need to spend at least 20 hours a week working, volunteering, going to school or getting substance abuse treatment, among other work-related options. That change would require approval from the federal government in order to be implemented.

Another provision would end Missouri's practice of chipping in for Medicaid health care costs for out-of-state patients who seek treatment in Missouri hospitals.

House Democrat Leader Crystal Quade said those provisions were an attempt to gain support for the amendment and distract voters from the main provision on Medicaid expansion.

"The people have spoken. The courts have spoken," Quade said in a statement. "It is long past time for House Republicans to listen."

The measure needs another vote of approval in the House to move to the GOP-led Senate, which for weeks has done little work amid a fight over redistricting.