The massive passed by Congress on Thursday will add new uncertainty to 惭颈蝉蝉辞耻谤颈性视界传媒檚 own budget, but the most costly portions would not hit the state for two years or more.
As Gov. Mike Kehoe signed the budget bills passed by lawmakers this year, in general revenue spending and issued a warning that the next budget won性视界传媒檛 have any extra money.
性视界传媒淭he Office of Administration性视界传媒檚 Division of Budget and Planning estimates a nearly $1 billion shortfall in general revenue starting in (fiscal year 2027),性视界传媒 Kehoe性视界传媒檚 news release stated.
The biggest portion of that shortfall will be in the Medicaid program, which became a prime target for cuts in the federal budget bill. , Missouri could lose approximately 14% of its federal Medicaid funding over the next decade, or approximately $17 billion.
Part of that reduction is due to people leaving the program. An analysis prepared at Princeton University estimates that people currently covered by Medicaid would lose coverage over the next 10 years.聽
But a large part of the 10-year impact would be costs shifted to the state. Missouri would either have to replace those funds, cut the range of services offered or end coverage for tens of thousands of people.聽
性视界传媒淭he bill being debated is going to blow a hole in our budget that will be hard to recover from,性视界传媒 said state Rep. Betsy Fogle of Springfield, the ranking Democrat on the Missouri House Budget Committee.
Missouri ended the 2025 fiscal year on Monday with a healthy $4.3 billion in the general revenue fund, plus another $1.3 billion that can be spent like general revenue. But the $50.8 billion budget for the current fiscal year consumes most of the money that can be spent like general revenue and about $2 billion more in general revenue than expected receipts.
Fogle said she opposed Kehoe性视界传媒檚 vetoes and said worries about future spending needs should prompt him to veto a tax cut measure on his desk, which he has said he will sign.
性视界传媒淚 do not understand why we are continuing to push that as a priority if the governor thinks he cannot pay his bills in future years,性视界传媒 Fogle said.
Missouri spends about $15 billion on Medicaid annually, but most of the money comes from the federal government. For every dollar from Missouri taxpayers, the state receives $1.80 to $9 of federal matching funds.
Missouri minimizes its use of general revenue in Medicaid by taxing hospitals, pharmacies, nursing homes and ambulance providers.
Missouri was already facing a shortfall of funding for Medicaid in the next fiscal year. Lawmakers this year used $778 million remaining from federal COVID-19 health care support that will have to be replaced in future years to maintain the program.
The changes in federal policy included in the budget bill that will add to the direct costs on Missouri taxpayers are:
- Lower federal match starting in federal fiscal year 2030 for adults ages 18 to 64 covered by the Medicaid expansion amendment passed by voters in 2020. The federal government currently covers 90% of the cost, pegged at $4.6 billion in the current budget.
- A cap on how much can contribute to state Medicaid costs starting in federal fiscal year 2028. The budget approved by Kehoe appropriates $1.1 billion from provider taxes.
- Cost-sharing for the Supplemental Nutrition Assistance Program, or SNAP, that is popularly known as food stamps. Starting in , Missouri would have to pick up a larger share of administrative costs, plus a portion of benefit costs based on the state性视界传媒檚 payment error rate.
Some states have laws repealing participation in the Medicaid expansion program for working-age adults, enacted in 2010, if the federal government does not maintain its 90% cost share promise. Missouri must cover that group because it is in the state constitution.
Missouri currently pays about 35% of the cost of covering about 900,000 people covered by traditional Medicaid.
Anyone who is enrolled now in the expansion group would be covered with a 90% federal share. For new enrollees after 2030, Missouri would have to pay 35% of the cost.
Every 10% of the total cost for Medicaid expansion shifted to Missouri would increase the cost for state taxpayers by about $460 million.
The cost of expansion could escalate quickly, said Timothy McBride, co-director of the Center for Health Economics and Policy in the Institute for Public Health at Washington University in St. Louis.
性视界传媒淭he churning in that population is pretty high,性视界传媒 he said in an interview with The Independent.
The bill would impose an 80-hour-a-month work requirement for many adults receiving Medicaid and food stamps, including older people up to age 65. Parents of children 14 and older would have to meet the program性视界传媒檚 work requirements.
The state will also have to verify eligibility every six months instead of annually.
性视界传媒淲e性视界传媒檙e going to lose some people who are not going to either be qualified because of the work requirements, or they性视界传媒檙e going to just not fulfill paperwork requirements,性视界传媒 McBride said.
The Senate bill freezes provider taxes at their current levels and reduces them for the states that have expanded Medicaid.
The hospital provider tax is the largest of the four in Missouri, accounting for about $900 million of the total.
性视界传媒淲e have been very consistent in our message that deep cuts to provider taxes will harm enrollees, access to care for all Missourians, hospitals and other providers, and the state性视界传媒檚 budget,性视界传媒 said Dave Dillon, spokesperson for the Missouri Hospital Association. 性视界传媒淲e性视界传媒檙e also committed to working with all partners at the state and federal level to minimize the harm if this framework is adopted.性视界传媒
Current federal law caps the provider taxes at 6%. Starting in federal fiscal year 2028, the cap would be lowered by 0.5 percentage points a year 性视界传媒 stopping at 3.5% 性视界传媒 for the 41 states like Missouri that have expanded Medicaid coverage to working age adults.
The current hospital tax rate for Missouri is 5%.
The second-largest provider tax is on nursing homes, but the reconciliation bill exempts the provider tax from cuts, said Nikki Strong, director of policy at the Missouri Health Care Association, the nursing home lobbying group.
The exemption helps, she said, but nursing homes are struggling to maintain adequate staffing and, in many cases in rural areas, are considering closing. Pressure on state revenue hurts the chances of getting increased rates, she said.
性视界传媒淔rom our perspective, any cuts that are going to impact general revenue in the budget, without replacement revenues, are not good at this point in time,性视界传媒 she said. 性视界传媒淚t is not going to benefit us.性视界传媒
The SNAP program has been paid for exclusively from the federal treasury since it was launched in the 1960s.聽
Under the bill, states will be required to contribute a percentage of those costs if their exceeds 6%. The U.S. Department of Agriculture counts benefit underpayments and overpayments as errors.聽
惭颈蝉蝉辞耻谤颈性视界传媒檚 would mean it would pick up about $160 million of the cost, plus an extra portion for administrative expenses.
性视界传媒淢issouri will struggle to pick up these costs,性视界传媒 said Amy Blouin, executive director of the Missouri Budget Project, 性视界传媒渁nd state lawmakers will face extremely difficult choices, like whether to get rid of SNAP in Missouri, eliminate optional benefits like home- and community-based services that keep people living in their communities, or cut funding for services like education.性视界传媒
This was first published by the Missouri Independent, a nonprofit, nonpartisan news organization covering state government, politics and policy, and is reprinted with permission.
