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Low-income parents are the group that would be most likely to be subject to the work requirement, as the elderly, disabled, and children would automatically be exempt.Most able-bodied people with Medicaid coverage are already working, or face significant barriers to employment (such as lack of transportation, lack of affordable childcare, lack of dental and medical care to treat conditions that may prevent the person from working, etc.).Sater’s legislation sought to allow the state to have greater flexibility over who’s covered under the program, It suggested that the global waiver could include work requirements for able-bodied adults, and “initiatives to promote healthy outcomes and reward personal responsibility,” including copays, premiums, and the use of HSAs.Former Governor Jay Nixon, a Democrat who pushed for Medicaid expansion in Missouri since 2012, was term-limited, and could not run in the 2016 election (although he said he would continue to advocate for Medicaid expansion after leaving office).
Starting in 2017, the states gradually started to pay a share of the expansion cost, but the states’ portion will never be more than 10 percent.Former US Navy SEAL Eric Greitens (a former Democrat, now a Republican), won the election, and is opposed to Medicaid expansion because of the cost to the state.Greitens continues to cite what he calls an “explosion” in government health care spending in the state, but health care experts in Missouri note that the spending growth has actually been fairly modest.Only Texas and Alabama have lower Medicaid eligibility caps, at 18 percent.If Missouri had expanded Medicaid, Families USA estimates that 293,000 people would be newly eligible for coverage.
A spokesperson for the Missouri Department of Social Services said that enrollment had been trending downward for some time.