Date: January 13th, 2026
To: Chair Pollitt and Members, House Legislative Review Committee
From: Lucas Caldwell-McMillan, Chief of Policy Staff, Empower Missouri
Re: Our opposition to HJR 154
On behalf of our staff, board, and coalition members convened by Empower Missouri, I stand in opposition to HJR 154. Empower Missouri believes that access to healthcare is a human right. HJR 154 threatens that right for hundreds of thousands of Missourians. In 2020, voters approved the creation of a constitutional amendment to expand the Medicaid program. The people have already spoken on this issue. Since Medicaid expansion became the law in Missouri, over 360,000 new individuals have been enrolled in the program. The U.S. Department of Health and Human Services already requires Medicaid work requirements under the new federal rules in H.R. 1. HJR 154 interrupts this implementation and would impose costly bureaucratic complications for the Department of Social Services and Missouri Medicaid enrollees.
The Department of Social Services has already started the process to implement the new Medicaid requirements by January 1, 2027, as required under H.R.1. HJR 154 will add uncertainty and unnecessary delays to the ongoing work of DSS. For example, HJR 154 bans the use of self-attestation for gig workers to verify the number of hours worked, but the current rules from the U.S. Department of Health and Human Services allow for the use of self-attestation when appropriate. If HJR 154 is placed on the ballot, DSS will need to plan to implement work requirements under two different sets of rules. Rather than promoting clarity or efficiency, HJR 154 would create confusion, duplication, and unnecessary administrative burden for both DSS and Medicaid enrollees.
HJR 154 would also impose additional costs to Missouri taxpayers. It removes the requirement that the Department of Social Services take all actions to maximize the federal dollars that Missouri receives for Medicaid. HJR 154 also prohibits utilizing Medicaid managed care organizations to assist with eligibility determinations. Coordinating and utilizing accurate information from managed care organizations to timely determine eligibility for an individual is a proven cost-effective tool for states. Removing this tool will lead to increased DSS staff time devoted to eligibility determinations and absent that, delays and errors in eligibility decisions. These increased costs would coincide with the estimated $14 billion loss of Federal Medicaid funding in Missouri over the first ten years of H.R. 1 implementation.
Finally, enshrining work requirements in Missouri’s constitution relies on false assumptions that Medicaid recipients are abusing the social safety net. The frontline service providers in our coalition will tell you that this couldn’t be further from the truth. Most Medicaid recipients who can work are already working. A Washington University analysis of Medicaid recipients shows that 31 percent are already working enough to meet the proposed work requirements, and an additional 19 percent do work– but not enough to satisfy the proposed work requirements. Of those eligible for Medicaid who are underemployed, 18.9 percent have a child under the age of six in the household, and 13.7 percent report a health problem which limits their ability to work. Of those eligible for Medicaid but currently unemployed, 37.5 percent are ill or disabled, 12 percent are in school, and 24.3 percent are taking care of the home.
Empower Missouri joins multiple other organizations in urging a no vote on HJR 154. We appreciate your time and consideration.
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