Missouri Senate scales back Medicaid work requirements constitutional amendment
Senate committee strips down House proposal, opting instead to grant state officials broad authority to impose future work requirements on Medicaid recipients.
JEFFERSON CITY, MISSOURI — The Missouri Senate has significantly weakened a proposal to write Medicaid work requirements into the state constitution, instead opting to grant lawmakers and state officials broad authority to impose such requirements in the future.
The amended legislation, approved by a Senate committee last week, would give the Missouri General Assembly, the governor, or the state’s social services department constitutional power to establish work requirements for Medicaid recipients. This change represents a departure from the original House version, which would have mandated specific work requirements directly in the constitution.
State Sen. Jill Carter, a Republican from Granby who chairs the committee that approved the changes, sponsored similar legislation that served as the basis for the amended version. Dennis Rhodes, Carter’s chief of staff, said the modifications are designed to prepare Missouri for potential changes in federal policy.
Federal Law Changes Coming
The legislation comes as Missouri prepares for new federal requirements under the One Big Beautiful Bill Act passed by Congress. Starting January 1, 2027, the federal law will mandate new eligibility checks for adults covered through Medicaid expansion, the Affordable Care Act provision that extended coverage to more low-income adults.
Under the federal requirements, states must verify that Medicaid enrollees ages 19 to 64 are working, volunteering, or attending school for at least 80 hours per month to obtain or maintain coverage. States will also need to conduct eligibility checks twice yearly instead of the current annual reviews.
Constitutional Barriers to Work Requirements
The Missouri Constitution currently prohibits “greater or additional burdens or restrictions on eligibility standards” for people who qualify for coverage under expanded Medicaid. This constitutional language prevents the state from implementing work requirements under current law.
“Currently, we can’t do work requirements,” Rhodes told The Missouri Independent.
The original House legislation would have permanently enshrined work requirements in the state constitution, making them mandatory even if federal law changed in the future. The Senate committee’s version takes a more flexible approach, authorizing but not requiring the implementation of such requirements.
Voter Approval Required
Any changes to the Missouri Constitution must be approved by voters before taking effect. The amended proposal would need to appear on a statewide ballot and receive majority support to become law.
The Senate version mirrors legislation previously introduced by Carter, reflecting Republican efforts to maintain state flexibility while preparing for federal mandate compliance. The committee’s decision to scale back the original proposal suggests some lawmakers prefer preserving future policy options rather than locking specific requirements into the constitution.
Missouri expanded Medicaid coverage in 2021 following voter approval, extending healthcare benefits to approximately 275,000 additional residents. The upcoming federal changes will directly impact this expanded population, requiring new administrative processes and eligibility verification systems.
The legislation now moves to the full Senate for consideration, where lawmakers will debate whether to adopt the committee’s more flexible approach or push for stronger constitutional mandates.
