A constitutional amendment asking Missourians to let lawmakers decide year-to-year whether the state will offer Medicaid to working-age adults moved closer to passage Wednesday.
By an 8-5 vote, the Senate Appropriations Committee sent the House-passed proposal to the full Senate for debate. Only Sen. Lincoln Hough, R-Springfield, voted with Democrats to oppose the measure, which is seen by critics as an effort to roll back voter-approved Medicaid expansion.
If approved in the Senate, the measure would appear on the August or November election ballot.
Since Oct. 1, just more than 100,000 people have enrolled in the program that provides medical coverage for people with incomes less than 138 percent of the federal poverty limit. In the budget for the fiscal year that begins July 1, the cost of expansion is pegged at $2.5 billion.
The House-passed budget plan does not use any general revenue to pay the cost. Instead, it taps extra federal funds being sent to Missouri because it expanded eligibility to pay a part of the state's 10 percent match.
The amendment debated Wednesday is intended to give future lawmakers options when the state hits tough economic times, committee Chairman Dan Hegeman, R-Cosby, said after the vote.
"I have always had the concern that at some point in time, in the future, we will be pitting other general revenue-source expenditures against the expanded Medicaid because there was no other funding mechanism included," he said.
In August 2020, Missouri voters approved a constitutional amendment requiring the state to offer Medicaid coverage to 19- to 64-year-olds.
A single person is eligible with earnings up to $18,754 a year, or about 32 hours a week at the current minimum wage. For a household of three, the limit is $31,781 per year, or what a person working full time would earn at $15.29 per hour.
Prior to passage, only very low-income adults with children were eligible for coverage and no working-age adults without children could enroll.
Making the coverage optional for the state budget would break faith with the voters who passed the expansion program, said state Sen. Lauren Arthur, D-Kansas City.
"It seems pretty clear this is an attempt to undo what the voters did on Medicaid expansion," she said. "It is disrespectful to the people who have spent hours on line trying to enroll."
That view was echoed by Sen. Karla May, D-St. Louis, who said ending Medicaid expansion would hurt rural Missourians who have limited access to health care providers.
"We should not be in a hurry to deliver this piece of legislation to the floor whatsoever," May said.
An attempt to block the expansion program last year by withholding funds was overturned in July by the Missouri Supreme Court. Opponents argued lawmakers had the option to refuse to pay for the expanded population's care because of a constitutional provision that bars initiatives that appropriate funds.
The high court, however, ruled the amendment only set eligibility standards and did not directly appropriate money and therefore was constitutional.
Missouri is sitting on a record general revenue surplus that could reach $3 billion or more in the coming fiscal year. The state treasury is so flush with cash that the Missouri House is considering a bill to provide $1 billion in tax rebates.
The extra cost of expansion is expected to push the entire Medicaid budget to $16.6 billion in the coming year. The increasing cost is unsustainable, said Sen. Bill Eigel, R-Weldon Spring.
If the program is insolvent, it will hurt people more than denying coverage to the expansion group, he said.
The amendment, Eigel said, "asks for more clarification from the people of this state who were lied to by an out-of-state, special interest campaign."
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.