SJR 43 is a proposed constitutional amendment for Missouri that would revise the state’s MO HealthNet provision. The resolution repeals and replaces section 36(c) of article IV to continue Medicaid coverage for certain adults ages 19 through 64 who meet federal eligibility and income requirements, while expressly allowing the General Assembly to authorize work and community engagement requirements for able-bodied adult recipients. It also directs the Department of Social Services and the MO HealthNet Division to submit any necessary state plan amendments to federal officials and to take steps to maximize federal matching funds.
The measure defines the covered benefit package by reference to MO HealthNet benchmark or benchmark-equivalent coverage and locks in the federal and state statutory references as they existed on January 1, 2019. It would be submitted to voters at the next general election in 2026, or at a special election called by the governor, and the ballot summary asks whether the Missouri Constitution should be amended to permit work and community engagement requirements for able-bodied adult Medicaid recipients.
Impact
If adopted, the resolution would change the Missouri Constitution’s Medicaid expansion language and affect how MO HealthNet eligibility is administered for adults under age 65 with incomes at or below the specified threshold. It would preserve coverage for the expansion population while giving the legislature constitutional authority to impose work and community engagement requirements, subject to federal approval and implementation by the Department of Social Services and MO HealthNet Division. The amendment would also require state agencies to pursue federal approval and funding, and it would tie the operative legal references to January 1, 2019 versions of federal and state authorities.
Sentiment
Based on the bill text and ballot language, the measure appears to be framed as a policy adjustment rather than a full rollback of Medicaid expansion, with an emphasis on adding work and community engagement requirements for able-bodied adults. No committee transcripts or recorded votes are provided, so there is no direct evidence of debate or formal support/opposition in the available materials. The official summary language suggests the central political framing is around work requirements for Medicaid recipients.
Contention
The main point of contention is the authorization of work and community engagement requirements for able-bodied adult Medicaid recipients. Supporters would likely view this as a condition for continued coverage and a way to align eligibility with participation expectations, while opponents would likely argue that such requirements create barriers to coverage and could reduce enrollment among eligible adults. Another potential issue is the extent to which the amendment preserves existing MO HealthNet expansion protections while allowing new restrictions, and whether those restrictions would be consistent with federal Medicaid rules and approval requirements.