Resolution would add work requirements for Medicaid

By Abigail Didonna, Missouri News Network
JEFFERSON CITY — A resolution was heard Wednesday that would implement work requirements for Medicaid access, putting the Missouri Constitution in line with provisions of the “One Big Beautiful Bill Act.”
House Joint Resolution 154, sponsored by Rep. Darin Chappell, R-Rogersville, would amend the Missouri Constitution to align with the federal government’s work requirements for access to Medicaid.
On Jan. 1, 2027, the federal government will require 80 hours of work a month to be eligible for Medicaid, as a result of the One Big Beautiful Bill Act, or House Resolution 1, which passed July 2025.
“This would simply make the changes that are going to go into effect regardless, into effect permanently,” Chappell said to the Senate Families, Seniors and Health Committee.
The resolution would be placed on the November 2026 general election ballot.
Chappell’s resolution prevents the Missouri Department of Social Services from utilizing optional exemptions, such as exemptions for short-term hardships during hospitalizations, natural disasters and other emergencies.
The resolution would allow the department to use an exemption only if a general statute law is passed that specifically authorizes it.
The potential removal of optional exemptions was the main topic of concern during Wednesday’s committee hearing.
Emily Kalmer, a spokesperson for the American Cancer Society Cancer Action Network, worries that this resolution will tie the Department of Social Services’ hands.
“Our point is that this is taking away some of the options that the federal government specifically provides for, and we need all options on the table at this point,” Kalmer said.
Kalmer also said the federal government will not provide implementation guidance for the work requirements until June, and has concerns with setting the resolution on the ballot before the state fully knows the federal requirements.
“My concern is putting something before the voters that would lock it into the Missouri Constitution right now when we don’t know yet what is coming down, and what the department may need the options to do,” Kalmer said.
Another topic of concern at the meeting was the protections regarding caregivers of vulnerable adults.
In HR 1, there is an automatic exemption of the work requirement for caregivers of adults with disabilities. However, caregivers of vulnerable adults are not automatically exempt and would require an exemption not included in Chappell’s HJR 154.
Vulnerable adults are a broader category for people who don’t meet the federal definition of disabled, but are still unable to care for or protect themselves.
Jay Hardenbrook, director of advocacy at AARP Missouri, said this is his largest concern with the piece of legislation.
“Our main concern is that caregivers of vulnerable adults are exempt from work requirements,” Hardenbrook said. “One thing that we know for sure is that if this resolution passes with the current language, they would not be exempt.”
When asked by Committee Chair Sen. Jill Carter, R-Granby, Chappell said he would be willing to adjust the resolution to include protections for caregivers of vulnerable people.