The Missouri legislature will return to Jefferson City at noon today for a special session called yesterday by Governor Mike Parson.  Here’s a quick rundown of what you need to know:

Why did the Governor call a special session? 

During the regular session, the legislature failed to reauthorize something called the Federal Reimbursement Allowance, better known as the FRA. It needs to be reauthorized on an annual basis, creating the need for a special session.

What is the Federal Reimbursement Allowance?

The FRA is a tax on hospitals, nursing homes, pharmacies and other healthcare providers. This tax has been in place for about 30 years in Missouri, and the revenue generated from the tax provides the funding for Medicaid that is then matched by the federal government at a much higher amount.  According to the Missouri Budget Project, it is estimated that provider taxes will bring in nearly $1.6 billion in fiscal year 2022, which will allow us to draw down $2.9 billion in federal funds for Medicaid in Missouri. According to the Missouri Hospital Association, the allowance is the third largest source of revenue for the state.

So is this about Medicaid expansion? 

Nope! That is a totally separate issue currently being litigated in the courts. The FRA is a key funding mechanism for our current Medicaid program. 

So, why didn’t they reauthorize it this session? 

Senators Paul Wieland & Bob Onder were insistent that the reauthorization bill have language amended to it that would prohibit the use of Medicaid funds for drugs or devices “that may cause the destruction of, or prevent the implantation of, an unborn child.”  This would include the morning-after pill and some contraceptive devices, including IUDs.  

While many individuals oppose this language on ideological grounds, there is a more fundamental issue at play. According to the Missouri Family Health Council, under federal Medicaid law, state Medicaid programs must furnish “family planning services and supplies . . . to individuals of child-bearing age who are eligible under the State plan and who desire such services and supplies.” Additionally, state Medicaid programs must provide eligible Medicaid recipients with family planning services that are free from coercion or mental pressure and they must be free to choose the method of family planning they want to use. If Missouri Medicaid recipients select an IUD as their chosen method of contraception, and Missouri law prevents them from accessing that method, which is a violation of federal Medicaid law.  Violation of federal Medicaid law would make Missouri ineligible for federal Medicaid funds. 

Why should I care?

Reauthorizing the FRA is one of the most important responsibilities of the legislature each session, and the Missouri legislature has neglected to fulfill this essential duty. Not only does this jeopardize our healthcare system across the state, it creates a serious crisis within the Missouri budget. Without the matching federal funds for Medicaid, Missouri will have to fully foot that bill, meaning that funding for other programs will have to be dramatically reduced or eliminated. This means significant cuts to education, social services, and job training programs.

In addition, there is a disturbing conflation in the Wieland language between abortion drugs and birth control. The Hyde Amendment already prevents the use of federal funds to pay for an abortion, so that language is superfluous. Birth control, on the other hand, is an important tool for women to aid them in making conscientious decisions about having children. It is a right of all women to prevent unwanted pregnancies with birth control, and it is especially important for women of limited means (such as women who qualify for Medicaid) to have access to birth control if they wish to prevent conceiving a child for whom they cannot provide.  

According to the CDC, 99% of American women ages 15-44 who have had sex have reported using some form of birth control. A recent Gallup poll finds that 92% of Americans find birth control morally acceptable. Eighty-six percent of all American adults support access to all methods of contraception. So why is there a group of Missouri legislators trying to block poor women from accessing certain types of contraception? 

So what happens next?  

Gov. Parson has given the legislature one week– until Tuesday, June 29th– to pass the FRA reauthorization. If they don’t pass it by the 29th, the Governor has said that he will slash $591M from the FY22 state budget in anticipation of making up for missing funds. Impacted areas are reported to be community colleges and four-year universities, capital improvement projects, K-12, early literature programs, school safety planning, A+ and dual program funding credit, career center improvements, school transportation funding, social services and foster care and adoption services.

What can I do? 

Call your State Senator & Representative this week and tell them to pass a Clean FRA (no language limiting contraception options for women).

Mallory Rusch
Executive Director