Missouri’s proposed Medicaid work requirement would mandate adults aged 19-64 in the state’s Medicaid expansion to log 80 hours of work, education, job training, or community service monthly. Exemptions would apply to children, pregnant women, and those with disabilities. With a federal deadline looming, the proposal aims to solidify these rules in Missouri’s constitution, ensuring they remain even if federal policies change. Republican Representative Darin Chappell argues the goal is not just compliance, but to help individuals break free from reliance on assistance programs.
Constitutional Safeguard or a Strategic Rollback
The constitutional approach represents a significant escalation in the long-running dispute over Medicaid expansion in Missouri. Voters approved expanding Medicaid coverage in 2020, and the current constitution includes language barring greater restrictions on that expansion population. The proposed amendment would remove that protective clause and eliminate a requirement that the state seek maximum federal funding for expansion.
Chappell framed the constitutional route as prudent long-term planning. By embedding work requirements in the state constitution, Missouri would maintain these rules even if a future president or Congress repeals the federal mandates. The state proposal essentially mirrors what federal law already requires, he noted, but adds durability against political changes in Washington.
The amendment would apply specifically to the Medicaid expansion group, not to traditional Medicaid recipients. Supporters argue this targets working-age adults who can participate in the workforce while preserving coverage for the most vulnerable populations already exempted under the proposal.
House Minority Leader Ashley Aune, a Democrat from Kansas City, offered a sharply different interpretation of the motives behind the constitutional approach. According to Aune, Republican lawmakers are pursuing this strategy because courts have blocked similar attempts through regular legislation. She characterized the work requirements as attractive language that might persuade voters to approve broader constitutional changes that weaken the 2020 expansion protections.
November Vote With Certain Federal Implications
The resolution now heads to the Missouri Senate, where its fate remains uncertain. If senators approve the measure, Missouri voters will decide in November whether to amend their constitution with these work requirements and the accompanying removal of expansion protections.
Regardless of what happens in the Senate or at the ballot box, Missouri must implement the federal work verification system by the start of 2027. The One Big Beautiful Bill Act requires semiannual recertification for expansion enrollees, and the state cannot avoid that obligation even if voters reject the constitutional amendment.
The dual timelines create an unusual dynamic. Federal requirements take effect in less than a year regardless of state action, meaning Missouri’s Medicaid system will change in 2027 no matter what. But the constitutional amendment would lock those changes in place permanently at the state level, preventing future lawmakers or governors from easing or removing them without another voter referendum.
For now, the proposal awaits Senate consideration while advocacy groups on both sides prepare for what could become an expensive and high-profile campaign if the measure reaches the November ballot. The outcome will determine not only whether work requirements exist in Missouri but also how difficult they will be to change in future years.
