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Key Takeaways:

  • Missouri voters approved Amendment 2, which expands the state’s Medicaid program under the Affordable Care Act.
  • Missouri becomes the 38th state to expand Medicaid under the ACA and the sixth state to expand Medicaid via a ballot measure.
  • Voters in both states to expand their Medicaid program in 2020, Missouri and Oklahoma, have amended their state constitutions, which will protect expansions from opponents looking to delay or repeal the measure.

On Tuesday, Missouri voters approved Amendment 2, which expands the state’s Medicaid program to those below 133 percent of the federal poverty level under the Affordable Care Act (ACA). The expansion is expected to provide health coverage to an additional 217,000 residents. Approval of Amendment 2 makes Missouri the 38th state to expand Medicaid under the ACA and the sixth state to expand Medicaid via a ballot measure. 

Earlier this year, Oklahoma voters approved a similar ballot measure amending the Oklahoma Constitution. By enshrining Medicaid expansion language in the state constitutions of Oklahoma and Missouri, proponents of Medicaid expansion have made it more difficult for opponents in the state legislature or governor’s mansion to delay or repeal the measure. Notably, after voters approved a ballot measure to expand the state’s Medicaid program in 2018, Nebraska lawmakers delayed implementation of the program until 2020. 

Currently, no state’s have certified any additional ballot measures to expand Medicaid programs for the November 3, 2020, general election ballot. 

Background

Medicaid is the government health care program for low-income families and adults. Established in 1965, state and federal governments jointly fund it, and the states largely manage their own Medicaid programs, although they must meet minimum requirements to receive federal funds. Although the Medicaid program is voluntary for states, all 50 states have participated since 1982. Medicaid currently provides health insurance for over 70 million people.

In an effort to increase health insurance coverage, the ACA included provisions directing all states to expand their Medicaid programs for residents earning up to 133 percent (effectively 138 percent) of the federal poverty level. However, the U.S. Supreme Court ruled in 2012 (National Federation of Independent Business v. Sebelius) that the ACA could not force states to expand their Medicaid programs.

With the Supreme Court making Medicaid expansion optional, a majority of states and Washington, D.C., chose to expand their Medicaid programs as directed under the ACA. Several additional states chose to expand their Medicaid programs under alternative models approved by the federal government via 1115 waivers (authorized under Section 1115 of Social Security Act)