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B.70, introduced by Senator Jill Schupp (D, 24th District), called for the expansion of Medicaid as called for in the ACA, effective January 2018. Vermont and Rhode Island have global waivers, but neither is a block grant (here’s more about Vermont’s, and here’s more about Rhode Island’s).

The bill did not advance, which wasn’t surprising, given that Republicans control the Missouri legislature, and that Donald Trump’s win emboldened their rejection of the ACA — including Medicaid expansion. B.28, introduced by Senator David Sater (R, 29th District), called for Missouri to submit an application to CMS for a “global waiver” for Medicaid, which would allow the state to receive Medicaid funds under a block grant, rather than the current open-ended matching system that the federal government uses. A global waiver requesting a block grant structure would have been extremely unlikely to be approved under the Obama Administration, but could potentially be approved under the Trump Administration.

And because residents in states not expanding Medicaid still have to pay federal taxes, Missouri residents have been paying for Medicaid expansion in other states since 2014.

By 2022, people in Missouri will have paid .3 billion in federal taxes used to pay for Medicaid expansion in other states.

They were already eligible for Medicaid under the existing guidelines, but had not enrolled prior to the opening of the ACA exchanges.Low-income parents are the group that would be most likely to be subject to the work requirement, as the elderly, disabled, and children would automatically be exempt.Most able-bodied people with Medicaid coverage are already working, or face significant barriers to employment (such as lack of transportation, lack of affordable childcare, lack of dental and medical care to treat conditions that may prevent the person from working, etc.).A spokesperson for the Missouri Department of Social Services said that enrollment had been trending downward for some time.But by January 2018, total enrollment in CHIP and MO Health Net had grown to 959,354 people – an increase of 13 percent since the fall of 2013.

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This increase in enrollment — despite the fact that the state hasn’t changed their eligibility guidelines — is known as the “woodworker effect,” as people already eligible for Medicaid came “out of the woodwork” due to the increased outreach and advertising that went along with the implementation of the ACA’s exchanges. The state’s uninsured rate fell slightly to 11.7 percent in 2014, and dropped again to 9.8 percent by 2015, and to 8.9 percent by 2016.