Missouri House effort to defund Medicaid expansion a ‘work in progress’

Despite pushback from some Republican senators and Gov. Mike Parson, the Missouri House is plunging forward with its plan to essentially defund the Medicaid expansion voters approved in August.

The House Budget Committee on March 25 in a partisan 20-9 vote shot down House Bill 20[1], which sought to allocate $130 million in general revenue to secure $1.9 billion in federal funding to pay for Medicaid expansion for about 275,000 Missourians approved under Amendment 2.

HB 20 was filed by House Budget chair Rep. Cody Smith, R-Carthage, to segregate Medicaid expansion appropriations from other Medicaid spending bills and require it be to separately approved.

HB 20’s defeat means there was no money set aside for Medicaid expansion in the $34.6 billion budget the House sent to the Senate after approving 13 appropriation measures and a supplemental budget bill on April 1

The House proposed Fiscal Year 2022 (FY22) budget is $2.2 billion below Gov. Mike Parson’s January FY22 budget request primarily because it does not include the $1.9 billion for Medicaid expansion.

The day after the House Budget Committee shot down HB 20, Smith introduced HB 21[2], which would redistribute the $130 million in state money that Parson earmarked for Medicaid expansion and spend it elsewhere.

Smith outlined that he wants the money directed to other needs Tuesday when HB 21 was heard by the House Budget Committee for the first time.

Smith is proposing to direct $53 million to mental health care services, $61 million to in-home care of the elderly and disabled, $18 million to school transportation and $1 million to the state’s public defender office.

“This is still a work in progress,” he said.

Democrats remain enraged over what they characterize as the GOP-controlled House ignoring the will of the people.

“House Republicans have deliberately created a false choice between expanded Medicaid and other services. It’s important to remember Gov. Parson’s budget recommendations cut ZERO dollars from other state programs,” the House Democratic Caucus tweeted.

It remains uncertain how the House budget without Medicaid expansion and HB 21 will fare when, or if, they get to the Senate as is.

The Senate Appropriations Committee begins reviewing the House’s preliminary budget this week and some GOP leaders in the upper chamber have been dubious of Smith’s efforts.

Sen. Lincoln Hough, R-Springfield, vice chair of the Senate Appropriations Committee, told the Springfield News-Leader last week that lawmakers are legally obligated to fund expansion.

“It’s in the state constitution,” he said. “The voters approved it and we’re going to find a way to fund it.”

Parson in various recent comments noted he “put the money in the budget for that” and that even though he opposed Amendment 2, it’s his job to execute the will of the people

“I thought it was my obligation as governor to make sure we try to get it implemented. We’ll see what the Senate does and we’ll see how it comes out at the end of the day,” he said.

Under the recently adopted American Rescue Plan, Missouri would receive around $1.15 billion in additional Medicaid funding. In addition, Missouri is receiving about $2.8 billion in federal emergency stimulus money and will get an additional $1.5 billion over the next two years if it expands Medicaid.

State Budget Director Dan Haug told the budget panel Tuesday that Missouri’s net general revenue collections increased for the year by more than 15 percent compared to the same time in 2020.

Through March, individual income tax collections rose more than 16 percent for the year, from $5.25 billion in 2020 to $6.15 billion this year, Haug said.


  1. ^ House Bill 20 (house.mo.gov)
  2. ^ HB 21 (house.mo.gov)