Missouri Republicans Push for Medicaid Work Requirements in State Constitution

Proposed amendment would permanently embed work rules, drawing criticism from Democrats

Published on Feb. 24, 2026

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The Missouri House has passed a bill that would ask voters to amend the state constitution to require Medicaid recipients to work or volunteer 80 hours per month in order to maintain coverage. The proposed amendment, modeled after federal Medicaid work requirements, is intended to help people 'move out of poverty' but has faced opposition from Democratic lawmakers who argue it is 'designed to humiliate and degrade people'.

Why it matters

The move to enshrine Medicaid work requirements in the state constitution would make them harder to change in the future, even as federal rules on the issue continue to evolve. It raises concerns about potential coverage losses, especially for vulnerable populations like cancer patients.

The details

Under the proposed amendment, Medicaid recipients would need to work, volunteer, or be enrolled in school for 80 hours per month to maintain coverage. Exceptions would apply for pregnant women, people with disabilities, and children. The bill passed along party lines, with Democrats arguing it is redundant since federal Medicaid work requirements are already set to take effect in 2027.

  • The Missouri House has passed the bill.
  • The bill now moves to the Missouri Senate.
  • If passed by the Senate, Missouri voters would have the final say on the measure in November.

The players

Darin Chappell

Rogersville Republican state representative who sponsored the proposed constitutional amendment.

David Tyson Smith

Columbia Democratic state representative who criticized the proposal as 'designed to humiliate and degrade people'.

Emily Kalmer

Representative of the American Cancer Society, who expressed concerns that the state amendment could cause some cancer patients and survivors to lose coverage.

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What they’re saying

“The goal is to get people to find a way to extricate themselves from the cycle of poverty. We're not trying to ignore the fact that people need help, but at the same time, it ought not become a lifestyle.”

— Darin Chappell, State Representative (ky3.com)

“There's no reason to do this. It's really designed to humiliate and degrade people and to push the message out that people receiving Medicaid are lazy.”

— David Tyson Smith, State Representative (ky3.com)

“We want to make sure that people have access to health insurance because that's the most important thing for someone to survive a diagnosis like cancer. The federal law provides some exemptions for short-term hardship, and this joint resolution is saying that Missouri won't have those short-term hardship exemptions.”

— Emily Kalmer, American Cancer Society (ky3.com)

What’s next

If passed by the Missouri Senate, the proposed constitutional amendment would be put to a vote of Missouri voters in November.

The takeaway

The push to enshrine Medicaid work requirements in Missouri's constitution highlights the ongoing partisan debate over the role of work mandates in social safety net programs. While proponents argue it will help people 'move out of poverty', critics contend it will unfairly burden vulnerable populations and make the rules harder to change in the future.