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Missouri committee hears debate on HJR 154; sponsors say work requirements will boost employment, health groups warn of coverage loss
Summary
Supporters told a House committee HJR 154 would mirror federal HR 1 work requirements and encourage employment; health advocates, AARP and budget analysts warned the constitutional change could prevent optional exemptions, increase administrative costs, and lead to coverage losses for vulnerable Missourians.
The Missouri House committee on legislative review heard testimony on HJR 154 on Thursday, a proposed constitutional amendment to align state Medicaid eligibility rules with the federal HR 1 work‑requirement framework that must take effect Jan. 1, 2027. Sponsor Representative Chaplain said the measure is intended to mirror federal law and to encourage able‑bodied adults to return to work.
Chaplain told the committee the proposal would require eligible individuals aged 19 to 65 to meet 80 hours per month of work, community service, enrollment in a work program or part‑time study to maintain coverage, with exemptions for those with qualifying disabilities and expectant mothers. ‘‘The best help we can give someone who is struggling is a job,’’ Chaplain said, describing the approach as modeled on federal changes and citing examples from other states.
Supporters included James Harris of FGA Action, who called the proposal a way to restore ‘‘dignity’’ through work and argued many states are pursuing similar changes; Harris also cited estimates and private‑sector vendors who say technology can lower verification costs. Harris told the committee he believes some administrative cost estimates (which he said DSS had placed as high as $30 million) can be reduced by private vendors.
Opponents — including the American Cancer Society Cancer Action Network, AARP and the Missouri Budget Project — urged caution. Emily Kalmer of the American Cancer Society warned that cancer patients and survivors often cannot work during treatment and said HJR 154’s language could ‘‘tie Missouri’s hands’’ by limiting optional federal exemptions such as short‑term hardship exemptions for people who must travel for care. Jay Hardenbrook of AARP said the legislature should preserve the ability to exempt family caregivers and wait for CMS guidance before locking rules into the constitution. Bridal Colby of the Missouri Budget Project warned that HR 1 shifts attention to program error rates, not just fraud, and said prescriptive language could increase the state’s exposure to CMS audits and payment disallowances.
Committee members questioned operational details and costs. Representative Fuchs pressed the sponsor on how officials would determine who is ‘‘capable’’ of working and how the proposal would protect people with serious mental‑health conditions; she raised scenarios in which someone who briefly gains employment could lose a job and then, without coverage, lose access to medication. Representative Crosley and others noted the fiscal note provided to the committee listed $9,000,000 in election costs but said that figure does not capture the likely implementation costs for staff, eligibility systems, vendor contracts and ongoing verification and re‑enrollment operations.
Several members suggested alternatives such as a trigger statute or waiting for CMS rules to be finalized, while the sponsor said he is open to refining language and that much of the additional cost flows from federal requirements the state must meet regardless. Witnesses and lawmakers repeatedly raised the risk of ‘‘churn’’ — the cycle of losing and regaining coverage because of administrative burdens — and the downstream consequences for rural hospitals and patients who rely on continuous coverage.
The hearing produced no committee vote; the session closed after public testimony. The next procedural steps for HJR 154 were not specified during this meeting.
