HB 10 is the state’s annual appropriations bill for the Department of Mental Health, the Department of Health and Senior Services, and the Missouri Health Facilities Review Committee for fiscal year 2026. It authorizes spending from general revenue, federal funds, and various dedicated funds for agency administration, state hospitals and regional centers, behavioral health, developmental disabilities services, public health programs, senior and disability services, cannabis regulation, and related transfers between funds. The bill also includes numerous targeted appropriations for specific initiatives such as crisis response, 988 services, opioid treatment and recovery, suicide prevention, autism services, maternal and child health, rural health, nursing workforce support, and veterans’ health programs.
A major feature of the bill is the large-scale funding of Medicaid-related behavioral health and developmental disability services, including community programs, waiver services, residential supports, psychiatric services, and provider payments. It also contains spending for state-operated facilities such as Fulton State Hospital, the Forensic Treatment Center, Hawthorn Children’s Psychiatric Hospital, and several habilitation and regional centers, along with flexibility provisions that allow some funds to be shifted among related service lines. The bill further directs money to public health functions such as disease control, emergency preparedness, newborn screening, vital records, tobacco cessation, HIV/STI/hepatitis services, maternal health, and senior services like home- and community-based care, caregiver support, and aging services.
The bill’s impact on state law is primarily fiscal rather than substantive: it sets spending authority, fund transfers, and conditions on how appropriated money may be used, while also imposing rate caps, reporting requirements, and program-specific restrictions. It limits certain provider rate increases, sets parameters for waiver slots and reimbursement levels, and requires monthly or written reporting to legislative budget committees on waiver costs, rate studies, federal compliance, and financial reports. It also establishes or continues numerous grant and contract programs, including some one-time appropriations, and directs how dedicated funds such as opioid settlement money, cannabis revenues, and veterans’ funds are to be distributed.
The general sentiment reflected in the voting history appears strongly supportive, with large bipartisan majorities in both chambers. The House passed the bill 138-15 on third reading and later 133-16 in conference, while the Senate passed it 28-6, suggesting broad agreement on the need to fund these health and mental health programs. The absence of committee transcript material limits insight into detailed debate, but the vote margins indicate the bill was viewed as a necessary and largely noncontroversial appropriations measure overall.
The main points of contention are likely the bill’s many targeted earmarks, rate limitations, and policy conditions attached to appropriations. Some provisions are highly specific to particular providers, localities, or facilities, which can raise concerns about fairness, geographic favoritism, or earmarking. Other potentially contentious items include restrictions on provider rate increases, the abortion-related funding limitation in the family planning section, and the use of opioid settlement and other dedicated funds for a wide range of programs. Even so, the final votes suggest these issues did not prevent broad legislative approval.
HB 10 appropriates more than $6.8 billion combined for the Department of Mental Health and the Department of Health and Senior Services, while also authorizing fund transfers, one-time spending, and detailed conditions on how money may be used. It affects state operations by funding hospitals, community-based care, public health programs, senior services, cannabis regulation, and numerous grant programs, while also setting rate caps, flexibility provisions, and reporting obligations that govern agency administration and provider payments.
Likely areas of contention include the bill’s many earmarked appropriations for specific organizations, cities, and facilities; the restrictions on provider rate increases; and policy riders tied to funding, such as the abortion-related limitation in the family planning section. Some lawmakers may also have objected to the use of dedicated opioid, cannabis, and veterans’ funds for broad programmatic purposes or to the concentration of funds in particular local projects. Despite these issues, the final votes show that objections were not strong enough to derail passage.