Missouri Lawmakers Advance Medicaid Work Requirement Ballot Measure

The proposed constitutional amendment would require many Medicaid recipients to work, volunteer or study to keep coverage.

Published on Feb. 25, 2026

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The Missouri House has approved a proposed constitutional amendment that would require many Medicaid recipients to document 80 hours per month of work, education, job training or community service in order to maintain their coverage. The measure now heads to the state Senate, and if it advances, Missouri voters will decide in November whether to enshrine these work requirements in the state constitution.

Why it matters

The proposal would embed Medicaid work requirements in Missouri's Constitution, potentially outlasting federal rules set to take effect in 2027 and altering protections added when Missouri voters approved Medicaid expansion in 2020. Democrats and some advocates warn the amendment could enable defunding or limiting Missouri's expansion population and lead to coverage losses, while Republicans argue it would encourage work and preserve resources for the most vulnerable.

The details

The House passed the proposed amendment 99-48 along party lines, sending it to the Senate. The measure, sponsored by Republican Representative Darin Chappell, would require adults ages 19 to 64 in the Medicaid expansion group to document 80 hours per month of work, education, job training, or community service, with exemptions for children, pregnant women, and people with disabilities. Chappell said the state proposal is intended to mirror federal work requirements enacted by Congress in July 2025 as part of the One Big Beautiful Bill Act, which will require states to implement work verification by January 1, 2027.

  • The Missouri House approved the proposed constitutional amendment in February 2026.
  • The federal work requirements are set to take effect in January 2027.
  • Missouri voters will decide on the state's Medicaid work requirement ballot measure in November 2026.

The players

Darin Chappell

A Republican member of the Missouri House of Representatives who sponsored the proposed constitutional amendment to require Medicaid recipients to work, volunteer or study.

Ashley Aune

The House Minority Leader, a Democrat from Kansas City, who opposes the proposed Medicaid work requirement amendment.

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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, Republican Representative (Newsweek)

“They know, because the courts told them explicitly, that they cannot do it statutorily, so they have to do it constitutionally. They are taking it to the voters, but they're putting ballot candy on there to make Missourians think that they're voting on work requirements, which the federal government has already told us we have to impose.”

— Ashley Aune, House Minority Leader (Newsweek)

What’s next

The Senate will take up the House-passed resolution, and if it advances, Missouri voters will then decide in November whether to amend the state constitution to require work or approved activities for many adult Medicaid expansion enrollees.

The takeaway

This proposed constitutional amendment highlights the ongoing debate over work requirements for Medicaid recipients, with supporters arguing it will encourage self-sufficiency and critics warning it could lead to coverage losses. The outcome of the November ballot measure will have significant implications for Missouri's Medicaid program and the state's low-income residents.