On August 4, Missouri became the 38th state to expand Medicaid, narrowly defeating Republican opponents to the tune of 53.25% to 46.75%. With this win, about 230,000 Missourians 19 to 64 years old who make up to $18,000 per year and a family of three that makes up to $30,000 will be eligible for the program.

“Missouri’s Medicaid expansion will provide a brighter future for hundreds of thousands of Missourians,” said Missouri Primary Care Association CEO Joe Pierle.  “We are proud of our efforts to get this important ballot measure across the finish line alongside a diverse coalition of stakeholders who understood this was the common-sense path for our state.”

The road to the finish line took nearly a decade in which the Missouri legislature had two chances to get it done and failed each time. Longtime advocates for Medicaid expansion contend that the years without expansion cost hundreds of Missouri lives. Now that expansion is a reality for Missourians, millions of tax dollars will return to the state annually to cover essential workers, veterans who do not qualify for VA benefits, near-retirees, along with many others who will become newly eligible enrollees. Additionally, rural hospitals will have an added safety net to thwart more closures, while health care jobs are not only saved but added. Now, critical policy work begins to implement the expanded version by next summer.

In a written statement by Health Forward Foundation CEO Qiana Thomason said, “In the weeks and months ahead, we will continue our efforts to ensure Medicaid expansion is fully and expeditiously implemented. We look forward to partnering with state officials and MO HealthNet to ensure the program works for everyone.” Health Forward was instrumental in leading expansion efforts in collaboration with Healthcare for Missouri and its Yes On 2 campaign.

For rural health care providers, many of whom serve on the front lines as COVID-19 wages on, the opportunity to expand Medicaid comes at a crucial time. “We are pleased that individuals who have been left in the coverage gap will have an opportunity to apply for Medicaid and potentially realize these benefits next year,” said Toniann Richard, CEO of the Health Care Collaborative of Rural Missouri, which owns five federally qualified health centers and two school-based clinics. “We see, firsthand, preventable diseases that become chronic because people have to choose between food and health care. Now, newly eligible enrollees will have more options, easier access, and better health because of Medicaid expansion.”

Jackson, Clay, Platte, Boone, Greene, St. Louis, and St. Charles counties overwhelmingly voted in favor of Amendment 2. On the other hand, rural voters across the state, many of whom are uninsured and live in towns where hospitals have closed, voted against expanding Medicaid.

As for estimated costs to implement Medicaid expansion, it is projected at around $200 million. Under federal law, Missouri will be reimbursed for 90% of the cost for newly eligible enrollees. State revenue declines due to COVID-19 were among the reasons some opposed the measure, but economists say the move to expand Medicaid will yield high dividends. The Center for Health and Economics Policy at Washington University’s Institute for Public Health in St. Louis suggests Missouri will realize a $39 million to $91 million decrease in Medicaid state expenditures through 2024.

This is one reason Amendment 2 was met with a broad coalition of support. Both left- and right-leaning organizations endorsed expansion including groups like Planned Parenthood, Missouri Chamber of Commerce, Missouri Hospital Association, Catholic Charities, and many others.

The 12 states that have yet to expand Medicaid include Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. Oklahoma narrowly passed expansion this past June.

The Affordable Care Act gave states the option to expand Medicaid January 1, 2014. To date, Nebraska is the only state that has passed Medicaid expansion without implementing it.

Lawmakers cannot make changes to Missouri Amendment 2, Medicaid Expansion Initiative (August 2020); any changes to this constitutional amendment will have to go before Missouri voters.