Legislative proposal would enact work requirements for Missouri Medicaid recipients

A proposed constitutional amendment that would impose work and reporting requirements on Missouri Medicaid recipients was debated in a state Senate committee Wednesday morning.

Sponsored by state Sen. Jill Carter, a Joplin Republican, the proposed constitutional amendment would require able-bodied Medicaid participants ages 19 to 49 to prove they are working or engaging in another qualifying activity as a condition for receiving health coverage.

Participants would need to complete 80 hours a month of work, education, job search, child care or volunteering. There would be various exceptions, including for those who are pregnant or primary caregivers to a dependent child or dependent adult.

If passed by the Legislature, it would be placed on the statewide ballot and need voter approval to go into law.

“This is an amendment that is similar to what the federal government is kind of pivoting to,” Carter said at the Senate’s Families, Seniors and Health committee hearing, “just trying to help people be more involved and engaged in the communities where they are receiving assistance.”

At the federal level, Republicans in Congress have said they’re eyeing work requirements for Medicaid, as well as deep cuts to the program. The last Trump administration encouraged state-level efforts to condition Medicaid on work and reporting requirements, and the second administration has shown interest in similar policies.

Carter said her bill is designed to help empower able-bodied Medicaid participants to better themselves by getting involved in their communities and escaping poverty.

“I see how poverty is and getting assistance is becoming a multi-generational cycle,” she said. “Instead of us helping people get out of that cycle of poverty, we’re capping them and keeping them entrapped in that.”

No one testified in favor of the bill Wednesday. Five people testified in opposition, arguing the requirements would amount to bureaucratic red tape that would cause the neediest Missourians to lose health care.

According to the health policy organization KFF, two-thirds of adults on Medicaid aged 19 to 64 already work.

Low-income Missourians, along with those with disabilities, qualify for Medicaid. For a two-person household of low-income adults without disabilities, for example, the annual income limit is $27,185 to qualify.

Emily Kalmer, a lobbyist for the American Cancer Society Cancer Action Network, said the proposal could drop cancer survivors and patients from the rolls who are unable to work.

“For a cancer patient losing coverage in the middle of treatment — that could seriously jeopardize their chances of survival,” she said.

Kalmer said although the exemptions may be “well meaning and intended to help”, in practice, those who qualify could still lose coverage because of administrative hurdles.

In Arkansas, where work requirements were briefly implemented, Kalmer said people intended to be exempt from work requirements still lost coverage because they didn’t know about the exemptions or weren’t able to navigate the reporting requirements.

Arkansas was the first state to adopt Medicaid work requirements in 2018. Until a court halted the program in 2019, around 18,000 people lost coverage.

Brian Colby, vice president of public policy at the progressive Missouri Budget Project, said other states’ experiences have shown that “this administrative task is very expensive, very hard to do and gets mixed up in court and the whole thing gets thrown out.”

Lucas Caldwell-McMillan, chief of policy staff with the anti-poverty organization Empower Missouri, said the proposal would add an “incredible extra layer of bureaucracy” onto an already-strained social services system.

“Social Services is struggling right now answering phone calls,” he said. “This would be a pretty dramatic increase: hundreds of thousands of folks, hundreds of thousands of forms, processes, people who need to call with questions, need to figure out which form they need to submit, get into the local office or get a hold of someone onto the phone.”

Caldwell-McMillan said the proposal would cause, “as we’ve seen in Arkansas, folks who are working, who are eligible, losing their Medicaid benefits.”

Missouri’s social services agency has struggled to meet federal standards for processing Medicaid applications. It is also being sued for its hourslong wait times for Supplemental Nutrition Assistance Program benefits.

The Department of Social Services also says it’s understaffed, and requested 220 new eligibility staff in its budget for this year. Gov. Mike Kehoe recommended only 55 new positions.

Caldwell-McMillan added that the many exemptions in the proposed amendment could “add an extra layer of complexity” in the bureaucratic process.

State Sen. Maggie Nurrenbern, a Democrat from Kansas City on the committee, pointed to issues with social services wait times already,

“What actually happens,” she said of work requirements, “is that the bureaucratic cost to it, really outweighs the benefit.”

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