Many Missourians who receive Medicaid would be required to work under a proposed constitutional amendment the House approved Thursday.
During initial debate on the bill last week, the sponsor, Rep. Darin Chappell, R-Rogersville, said that even though Missouri will have to have work requirements because of a federal law, those requirements could go away in the next presidential administration.
"Someday that law may be changed, and I believe that this is good policy, and it needs to be on a permanent level within the state," Chappell said.
If passed by Missouri voters, the amendment would require Medicaid recipients in an expansion group who are ages 19 to 64 to work or undertake a different approved activity for 80 hours a month. Missouri voted to expand Medicaid access through the Affordable Care Act in 2020.
Those who would be exempt from the work requirements include children, pregnant women and people with disabilities.
Other approved activities include job training, enrollment in an educational program and community service.
The House passed the proposed amendment 99-48. It now goes to the Senate.
Speaking before the vote, Chappell said the work requirements have multiple goals.
"It is to encourage people who are capable of reentering the workforce to do so, for them to have the pride of the fruit of their own labors, to reduce the need for continued Medicaid and other welfare programs provided for their lives, and to show everyone that those who are capable ought to be able to do so," Chappell said.
The vote was split between party lines. No Democrat voted for the proposed amendment.
"This is nothing more than an attack on Medicaid expansion," Rep. Jo Doll, D-Webster Groves, said. "There is no reason to alter the constitution. We know work requirements are not effective, and so by changing our constitution, we are asking for this to become the law of our state forever."
Congress last year, as a part of the One Big Beautiful Bill Act, passed work requirements for people within the Affordable Care Act's Medicaid expansion population.
States will have to implement work requirements by Jan. 1, 2027, though states could choose to do them earlier, or request an extension until December 2028.
This proposed constitutional amendment mirrors those federal requirements.
Several Republicans spoke in support of the legislation, including Rep. Becky Laubinger, R-Park Hills.
"Our state is prioritizing assistance that is focused on developing people's potential, giving them opportunities to work with mentors and volunteer situations or apply for jobs," Laubinger said.
Rep. Keri Ingle, D-Lee's Summit, expressed concern that even though children may be exempt from the requirements, there could be consequences for them.
"We can have this conversation about work requirements for able-bodied adults, but the people who fall through the cracks every single time are the kids," Ingle said.
Rep. Tiffany Price, D-Kansas City, said the extra steps to receive Medicaid will create more burdens for those seeking coverage.
"It is very disrespectful to the people that really need these services to insinuate that somebody wants to steal Medicaid and have the government all in their business," Price said.
The proposed amendment would repeal part of the Medicaid expansion constitutional amendment that voters passed. The state constitution currently bars the state from placing "greater or additional burdens or restrictions on eligibility or enrollment standards" for people eligible for Medicaid coverage.
Several organizations spoke against the proposed amendment in committee, including the American Cancer Society, which expressed concerns that cancer patients could lose coverage if they can't navigate the system.
The legislation is HJR 154.
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