MO HealthNet – Missouri House of Representatives Newsroom

House Republicans and Democrats agree: FRA must pass

One thing Republicans and Democrats in the Missouri House agree on is that the legislature must renew Federal Reimbursement Allowance (FRA) legislation this year, or a massive hole will be blown out of the state’s operating budget.

*House Speaker Dean Plocher and Minority Floor Leader Crystal Quade agree the legislature must pass an FRA extension this year. (Photos: Tim Bommel, Missouri House Communications)*

The FRA has been passed 17 times since 1992. It is a tax paid by Medicaid providers in Missouri which the federal government more than matches in paying it back to the state. That helps to cover the MO HealthNet program, and additional allowances also cover nursing facilities, pharmacy costs, and ambulance services.

House Speaker Dean Plocher (R-St. Louis) said failing to renew the FRA this year “would result in an almost 3.5 to 4-billion dollar hit to our annual state budget. I ask you [to join me] in passing the FRA because we simply cannot let Missourians down.”

House Democrat leader Crystal Quade (D-Springfield) agreed, “If we do not pass the FRA we will be out so much money, and where is that money going to come from? Public education, general revenue, and so when we have the conversation about the FRA it’s not just about making our Medicaid program solvent, it’s about making sure that we are funding all of the things necessary.”

For many years legislators described FRA renewals as non-controversial, but Quade pointed out that was not the case in 2021.

“It is deeply concerning. The last time the FRA was up we weren’t able to get it done [during the regular session]. We had to go to a special session,” Quade said during a media conference on the opening day of the 2024 session.

Plocher, asked during the Republicans’ media conference about the importance of FRA renewal, responded with his own question, “How vital is 3.5 to 4-billion dollars on a $50-billion budget? If we don’t get it passed I don’t think our budget can absorb a 3.5 to 4-billion dollar hit. I think it’s important. We passed it a couple of years ago. I look forward to tackling that issue now, but I don’t think we can’t afford not to pass it.”

The current FRA expires at the end of September.

Bills could help Missourians with disabilities advance their careers, get married

Missourians living with disabilities could no longer have to reject raises and promotions, or even choose not to get married, in order to keep receiving needed state assistance, under legislation now awaiting the governor’s action.

*Representative Melanie Stinnett (Photo: Tim Bommel, Missouri House Communications)*

Among legislation that was approved by the House and Senate last month was a provision to change the state’s Ticket to Work health insurance program within MO HealthNet. It would increase the limit on how much a person can earn before they lose benefits under that program. It would also not count up to $50,000 of a spouse’s income toward that limit.

Such state benefits provide to some Missourians with disabilities things like personal care attendants, medication, services, and equipment that allow them to have a job in the first place. Those Missourians must sometimes reject raises or promotions because the changes in income would not offset the benefits they would lose.

Another provision would require state agencies to use an “employment first” policy, directing them to recruit and keep employees with disabilities and create competitive ways to integrate them into workforces.

This legislation received broad, bipartisan support in both chambers. In the House they were carried by Springfield Republican Melanie Stinnett. She said legislators have been growing more aware of how state assistance programs designed to help Missourians are sometimes holding them back.

“When we look at how this language in the current statute was impacting their ability to continue taking those raises or getting a new job in a new area, or in our communities we hear issues with workforce all the time and we’re wanting to do upskill training and we’re wanting to do all of these things to help people improve their skills and improve their earning potential but for individuals with disabilities we put a cap on that, and that is not what we want to be doing. We want to allow individuals in our communities to work to their highest capacity and help them to thrive within their community.”

“It’s something that’s been worked on for nearly 20 years and there are a lot of people that have worked on it year over year over year, and I’m really happy to be a part of the team to bring it across the finish line,” said Stinnett.

Representative Bridget Walsh Moore (D-St. Louis) lives and works with a disability, and has long advocated for these changes. She said these will yield, “immediate, tangible results that are going to benefit so many people.”

*Representative Bridget Walsh Moore (Photo: Tim Bommel, Missouri House Communications)*

“We will have a different workforce by the end of this year. This goes into effect in August. By the end of the year … our workforce will look entirely different because these people can go after that promotion, apply for that new job, they can move up the ladder, now it’s worth it to go back to school and get that degree or my master’s because I’ll actually be able to get the job I want,” said Walsh Moore.

“This will have immediate results on the economy, immediate impact. When you go from making 40-grand to 80 overnight you’re going to spend that money. You’re either going to pay off debt, you’re going to get a better place to live, you’re going to go out to eat more, you’re going to buy new clothes, whatever. You’re going to spend that money. When you’ve been told that you have to penny pinch for so long, that money’s going to end up immediately back in the economy, so it’s a double benefit to the state. The state is only winning in this situation.”

Stinnett is particularly excited about the provision to ease the limit on a spouse’s income, “So we’re not disincentivizing marriage for individuals with disabilities, which I think is really important.”

About that provision Walsh Moore mentioned a childhood friend of hers who developed lupus.

“She is still living with her long-time boyfriend. She couldn’t get married because she would lose her benefits because her boyfriend makes too much money but he can’t solely support her. She could get married later this year. That’s huge,” said Walsh Moore. “You hear all the time of people divorcing so they can deal with medical issues – just divorcing on paper so that they can handle whatever disease has come into their life. It’s awful.”

Supporters of the employment first language said it was long overdue and would allow Missourians with disabilities to work to their fullest extent, which benefits the whole state.

Stinnett said it is, “showing that Missouri really values individuals with disabilities in our workforce and wants them to have options for competitive, integrated employment within their communities.”

Walsh Moore, who had advocated for this legislation since being elected in 2020 and said it has been proposed long before that, said, “It’s very exciting to finally see it done … it didn’t get a hearing every year but every year it did, no one has ever testified against it and no one has ever voted against it.”

Governor Mike Parson (R) has until July 14 to act on Senate Bill 106 and Senate Bill 45, both of which contain these provisions. He could sign them into law or veto them, or let them become law without his action. If they become law, the provisions would become effective on August 28.

Help for low-income and disabled Missourians a focus in final days of session

In the House, proposals that would help Missourians with disabilities, those with low incomes, and new mothers on state assistance, are being given every chance to become law before the end of the session next week. The chamber has voted to add those pieces of legislation to several bills that are still in play in these final days.

Among those is a transitional program meant to help people get off of state assistance gradually as their income increases. House members say the state’s assistance programs for low-income Missourians trap people in poverty because if they accept a raise that puts them above a program’s limits, they could lose more in state benefits than they gain from a raise.

The measure, sponsored by Representative Alex Riley (R-Springfield), would let people incrementally transition off of state assistance, “Trying to create this transitional system that encouraged people to work, that encouraged people to take those raises and to start to work their way up the income ladder and to hopefully, once this goes into effect, actually reduce the number of people receiving benefits in the state.”

That provision is the product of years of work by members of both parties. Lee’s Summit Democrat Keri Ingle called it a, “great bill … it’s been a bipartisan effort to essentially wean folks off of assistance, whether it’s TANF or SNAP, and make it easier for Missourians to get what they need to be successful working citizens while at the same time making sure that all of their needs are being met.”

The House has voted this week to add that language to two bills. It did the same for language sponsored by Representative Melanie Stinnett (R-Springfield) that could allow individuals with disabilities to finally be able to advance in their careers without worry of losing state assistance.

The changes to the state’s Ticket to Work health insurance program within MO HealthNet would increase the limit to how much a person can earn before they lose benefits, and would not count up to $50,000 of a spouse’s income toward that limit. It would also direct state agencies to have policies to recruit and keep employees with disabilities and create competitive ways to integrate them into workforces.

“These are people who are actually begging us to work, who want to work, who want to get promotions, who want to seek new jobs. What [this] bill does is address the fiscal cliff, making sure that you don’t have to do quite as much of a tap dance that too many people in our state are doing, where you’re allowed to make so much money but only to a certain point,” said St. Louis Democrat Bridget Walsh Moore.

Walsh Moore, who lives and works with a disability, said the benefits that individuals stand to lose often enable them to have a job in the first place. Things like, “a personal care attendant, your health insurance your additional services and equipment that you receive through the state that allow you to work. This would address and allow you to make more money, put that money back into the economy because if you make more money you’re going to spend more money.”

*Representative Alex Riley (Photo: Tim Bommel, Missouri House Communications)*

Also supported in the House this week has been a bipartisan plan to extend post-partum coverage under MO HealthNet or Show-Me Healthy Babies from 60 days to a year.

Stinnett, one of several sponsors of this proposal, said, “In 2019, 75-percent of pregnancy-related deaths in Missouri were determined to be preventable; those deaths that were attributed to things like embolism, hemorrhage, infections, concerns with cardiovascular health, chronic health conditions, and there’s one common denominator that can save these women’s lives, and that’s healthcare access.”

Several Republicans have cited this as an important pro-life provision. Representative Darin Chappell (R-Rogersville) said, “We who talk about being pro-life, I don’t know how we do that and then cut off the most vulnerable of our society after 60 days … I believe if we’re ever going to spend money [on benefits programs] it ought to be for those most vulnerable among us. Those very ones that we fought for them to be able to be born. We have to take care of them.”

Representative Tony Lovasco (R-O’Fallon) said even very conservative Republicans like himself could get behind all of these proposals, which don’t expand the state’s assistance programs.

*Representative Keri Ingle (Photo: Tim Bommel, Missouri House Communications*

“The reality is we are in a situation where we all, in all of our districts, have employers that are begging for workers. The number of unfilled positions right now is just astronomical and the idea that we as a state might incentivize people to stay home and not work and not take a promotion, not take a job opportunity because they might just make a slim little bit more money that puts them in a hole when it comes to feeding their family, well that’s just insane.”

Sponsors are hopeful at least one of the bills containing these provisions will reach the governor’s desk before the session closes at 6pm on May 12.

House votes to extend opportunities for more jobs, greater salaries to persons with disabilities

The House has voted to expand access to job opportunities and greater salaries to Missourians with disabilities by passing legislation that, backers say, will let those people simply live their lives.

House Bills 970 and 971 make changes to the state’s Ticket to Work health insurance program within MO HealthNet. The key provisions increase the limit to how much a person can earn before they would lose benefits under Ticket to Work and disregard up to $50,000 of a spouse’s income, relative to that limit. It will also direct state agencies to have policies to recruit and keep employees with disabilities and create competitive ways to integrate them into workforces.

The bills are carried by Representative Melanie Stinnett (R-Springfield), whose career in healthcare and as a speech-language pathologist has included a great deal of focus on serving the disabled community. She said she is honored to sponsor this legislation.

“It provides language that tells individuals with disabilities that we value them as important members of our community. It allows these individuals to enjoy the opportunity to enjoy competitive, integrated employment by decreasing barriers imposed by government,” said Stinnett.

She said these changes address outdated statutes that might have made sense in their time, but set limits that today are far too low.

“The restrictions we have in place limited them from being able to utilize the degrees that they had and the skills and the trades that they had in our communities in an effective way, and with today’s work force crunch, too, we certainly don’t want to be limiting our workforce,” said Stinnett.

The legislation has been offered in the House for about eight years. One person who has carried it throughout that time, Representative Sarah Unsicker (D-Shrewsbury), said individuals with disabilities have Missouri’s lowest unemployment rate, largely due to discrimination and lack of accommodation and understanding.

“Disability is a natural part of the human condition that affects everybody at some point in their lives, some sooner than others. The existence of a disability should not stop somebody from working and living to their fullest capacity,” said Unsicker. “There are people right now with master’s degrees who cannot work because of services they need just to get out of bed and survive and be physically able to meet the day even if they are mentally able to do incredible work. This will help them be taxpayers to the fullest extent of their ability. This will help people get jobs.”

Representative Bridget Walsh Moore (D-St. Louis) is a Missourian living and working with a disability and has also for several years sponsored this legislation. She said some people in the disabled community choose not to get married because if they do while the current limits are in place, they will lose their health benefits under Ticket to Work.

In her own life, said Walsh Moore, “If anything were to happen to me, my husband makes over $60,000. We would receive nothing from the state, zero support, and $60,000 for the two of us plus our child is not enough, especially with any medical needs I might have,” said Walsh Moore.

She said individuals need the benefits provided by that coverage to function daily, to hold jobs, and to live with dignity. She said she often thinks of a friend of hers who is in her 20s and has a master’s degree.

“She had to go to her job and say ‘Cap my salary at 40 grand.’ They wanted to pay her almost double that and she had to say no because even 80-thousand won’t make up enough to cover the assistance [she needs]. She is in a powered wheelchair so she has someone who helps her in morning and night, in getting in and getting out of bed and all that, and it’s not enough.”

“Missouri is losing out twice. They’re losing out on her income tax, and that’s another 40-grand that would have gone into our economy,” said Walsh Moore.

She said the provisions aimed at state agencies are intended to create a system that can be a model outside of government.

*Representative Sarah Unsicker (Photo: Tim Bommel, Missouri House Communications)*

“As the system stands, we have sheltered workshops and we have full competitive employment and no bridge in between. What this would do is basically set up the state as a model employer. Basically, we will figure out a program ourselves. All state departments will hire people with disabilities. We’ll kind of work out the kinks, figure out the program ourselves, and then we can sell it to corporate America,” Walsh Moore explained. “A lot of corporations I’ve talked to are very interested. They like the idea, they just don’t know what that looks like, and so we’re taking that burden off of them and saying we’ll do it first and we’ll figure it out.”

Stinnett, who is in her first year in the House, said this was one of the first issues she asked about taking up.

“It’s something that’s come up in my work life outside of this building and was a really important thing to me that I found disability legislation that I could get across the finish line that would make a difference for our everyday Missourians living with disabilities.”

The House voted 151-0 to send the legislation to the Senate, and has amended it to other bills.

Bipartisan set of bills would extend post-pregnancy healthcare

A bipartisan group of House lawmakers is sponsoring legislation that they hope will save the lives of women and infants in Missouri, and in doing so, move the state farther from the bottom in the nation in infant and maternal mortality.

*Majority Floor Leader Jon Patterson (R) (Photo: Tim Bommel, Missouri House Communications)*

Their proposals would extend MO HealthNet or Show-Me Healthy Babies coverage for low-income pregnant women to a full year after the end of their pregnancy. Currently that coverage stops after 60 days.

Six representatives have filed that proposal, including Majority Floor Leader Jonathan Patterson (R-Lees Summit).

“The wellbeing of the child is based upon the wellbeing of the mother, so that’s why we’re really worried about, and we really want to focus on, healthcare for the mother, because it affects the child,” said Patterson.

He says there are about 5,000 women in Missouri who don’t have insurance coverage either through the state, personal coverage, or an employer.

“The data are very clear that it’s critically important. You’re talking about the physical development of the child, development of the brain, that they have support, and one of those things is having a mother that can be there. For example if your mother is in the hospital for a mental crisis or high blood pressure they can’t be there for the child so that’s what we’re trying to avoid.”

*Representative LaKeySha Bosley (Photo: Tim Bommel, Missouri House Communications)*

Governor Mike Parson (R) in his State of the State Address earlier this month said, “we are heartbroken to be failing,” in the area of infant mortality, with Missouri ranking 44^th in the nation for its “abnormally high” rate.

Kansas City Democrat Patty Lewis calls the situation, “abysmal.” She said in a Department of Health and Senior Services report covering 2017 to 2019, “Something that was pretty astounding to me based on their findings is 75-percent of the deaths are preventable. As [someone with a] background in nursing, if we can prevent something that’s what I want to do,” said Lewis.

She said in the years covered by the report an average of 61 women died while pregnant or within one year of pregnancy, with 68 in 2018.

“If we can just save one that would be great, but saving 60 women I think would be very important to me.”

Freshman representative Melanie Stinnett (R-Springfield) said maternal healthcare was an issue that voters talked to her about leading up to her election in November.

*Representative Patty Lewis (Photo: Tim Bommel, Missouri House Communications)*

“I work in the realm of healthcare and I work with a lot of families with children with disabilities, specifically, but also work really closely with organizations like The Doula Foundation and midwife groups in Springfield so it’s certainly something that’s come up in Springfield and a topic that has been something that I’ve talked about in our community,” said Stinnett.

Representative Brad Pollitt (R-Sedalia) said the data about how many of those deaths could have been prevented weighs heavily on him.

He said the proposal, “is just giving a little extra healthcare to get them off on the right foot and to help the mother who may be having issues and I just think it’s the right thing to do.”

“It’s not the state’s job, it’s not the taxpayer’s job to financially take care of every individual from birth to death. That’s not what this is doing. This is giving someone an opportunity to start off on a better life and if we can do that then I just think it’s the right thing to do and I think it shows that we do care as a party about life after the baby’s born, and about the mother’s life.”

The Republican sponsors of the bill acknowledge that it also relates to their party’s identity regarding its pro-life stance. Bishop Davidson (R-Republic) said his party is often criticized as only supporting life before birth, but this bill is one thing that demonstrates otherwise.

“We carried it before that Dobbs case. We’re going to carry it after that Dobbs case. We’re interested in lives, and lives being fulfilled from conception to death, and so I see this piece of legislation as a part of a holistic agenda that is pro-life.”

Representative LaKeySha Bosley (D-St. Louis), who is for the fourth time sponsoring this proposal, says that it is “imperative” after Dobbs, “as we did pass the abortion ban, and [even] before we passed House Bill 126, the heartbeat bill, women who were in rural or underserved communities were dying [in] childbirth.”

Patterson agrees with his fellow Republicans, “We’re a pro-life state. I’m very proud to be pro-life, but that also means taking care of these children that are born. This is a measure that would ensure that the mother has healthcare for a year after they’re born, which is critically important to the wellbeing of the newborn baby.”

*Representative Brad Pollitt (Photo: Tim Bommel, Missouri House Communications)*

Bosley notes that while maternal mortality rates are an issue statewide, they hit some in Missouri harder than others.

“As an African American woman, as a minority in the State of Missouri … women who look like me are dying at a higher number and at a higher rate than our white counterparts.”

Bosley is glad that this proposal has gained more sponsors and a lot of media attention and she hopes it will lead to more.

“I’m happy that it’s a hot topic. Let’s go further than just the 12^th months. Let’s talk about doulas. Let’s go into the holistic conversation about how we can provide some assistance to doulas and have them be reimbursed,” adding, “Extending the coverage from the three months to the twelve months is just one of the small things that we can do, and it may seem small but it’s going to mean so much to a lot more people across the state.”

*Representative Bishop Davidson (Photo: Tim Bommel, Missouri House Communications)*

Patterson observes that the broad appeal of this plan isn’t limited to the House but extends to the Senate, where two versions have been filed and have already received a hearing. He and the other sponsors share great optimism that this will pass this year.

“It’s just a common sense measure that we can do to ensure the health of the babies.”

None of the House versions of this bill have been referred to a committee.

The bills that have been filed are: House Bill 91 (Patterson), House Bill 254 (Pollitt), House Bill 286 (Lewis), House Bill 328 (Bosley), House Bill 354 (Davidson), and House Bill 965 (Stinnett).

House approves bipartisan collaborative effort to extend Medicaid coverage for postpartum substance abuse care

A bipartisan, collaborative effort to extend Medicaid benefits for postpartum substance abuse treatment has been approved by the Missouri House.

Representatives Marsha Haefner, Martha Stevens, Cora Faith Walker, and Jay Barnes (photos; Tim Bommel, Missouri House Communications – click for larger version)

House Bill 2280 extends MO HealthNet benefits for pregnant women who are receiving substance abuse treatment within 60 days of giving birth for up to 12 additional months. Any participating woman must follow the treatment in order to benefit.

Bill sponsor Marsha Haefner (R-St. Louis) said extended treatment has been proven necessary for success.

“Opioid and substance abuse during pregnancy is on the rise, with opioid use during pregnancy mirroring that of the general population,” said Haefner. “The current time offered for substance use disorder treatment, which is 60-days for these new moms, does not allow for enough treatment for most women to experience success with recovery. If a new mom is doing well then loses support and treatment for her abuse she will often relapse. Another risk of pulling treatment too soon is after a period of non-use, women experience an increased risk of overdosing because their tolerance is low.”

HB 2280 was combined with similar bills filed by Representatives Cora Faith Walker (D-St. Louis), Martha Stevens (D-Columbia), and Jay Barnes (R-Jefferson City).

Stevens told lawmakers she was glad that the bill will cover a full range of treatments.

She said that one thing that came out of the committee hearing on the bill was that, “new moms need not just substance use disorder treatment. That we really need to have comprehensive, wrap-around services, and so I’m very pleased that this bill is full Medicaid coverage so that these new moms can get substance use disorder treatment, they can get mental health care, they can go see a primary doctor, and really support them that first year after giving birth.”

Representative Faith Walker commended the lawmakers involved in the legislation for the bipartisan effort that led to its passage.

“It is a very common sense, evidence-based approach to dealing with the opioid epidemic here in the State of Missouri and it will both save taxpayer dollars as well as save lives,” said Faith Walker. “I want to encourage the body to look at this effort that was put forward by all the bill sponsors moving forward for the rest of the session.”

Representative Keith Frederick (R-Rolla) said the bill represents something the legislature should do to help the most vulnerable in the state.

“The bottom line is that if we have ladies that are pregnant and have the struggle of addiction, they are in a special, vulnerable situation, as is their child,” said Frederick.

The bill’s projected cost is more than $4-million dollars through 2021, but Haefner noted it would save the state money that would have gone to caring for children who could go to state care if their mothers aren’t afforded treatment, and other cost avoidance. She said the budget the House is debating this week also includes money to pay for the projected costs to extend this coverage.

The bill has been sent to the Senate for its consideration. If it becomes law, the state will have to seek a waiver from the federal government to allow for the program to be created and implemented. Missouri would be the first state to seek such a waiver.

Haefner is hopeful the state could get an answer from the federal government by the beginning of 2019.