Missouri Focus

Medicaid Expansion

Missouri voters put Medicaid expansion into Missouri’s state constitution by a public vote of 53.25% to 46.75%.
Recently affirmed by the Missouri Supreme Court, Missourians across the state will finally be able to realize the health and economic benefits of Medicaid expansion by immediately enrolling.
Not only will Missourians have access to lifesaving care, but the entire state benefits from a more stable health care system, decreased medical debt and bankruptcies, and new economic activity.
Missourians who believe they are eligible for Missouri Medicaid benefits under the expanded Medicaid eligibility on July 1^st should apply at MyDSS.MO.gov.
- The online prescreen tool may use outdated eligibility guidelines until software is fully updated, resulting in some applicants getting a messaging indicating they are ineligible. However, YOU CAN STILL APPLY. You can hit “next” to continue with the application. We expect this glitch to be addressed soon and in the interim, applicants can continue through the process.
- If someone received medical services on or after July 1, 2021, Medicaid may cover these costs. They must include this information in their application and submit (or postmark) by October 31, 2021.
- Missourians needing assistance in applying for Medicaid can contact Cover Missouri at findlocalhelp.covermissouri.org or 1-800-466-3213.

Bills of Note Signed into Law

The Missouri General Assembly passed nearly 70 bills through both houses for consideration by Governor Parson. He concluded signing bills from the 2021 regular legislative session on July 14. In Missouri, bills passed during regular session go into effect on August 28; however, if a bill was passed with an emergency clause attached, it takes effect immediately upon the Governor’s signature.

Legislation of interest to BJC that Governor Parson signed into law:

Prescription Drug Monitoring Program (PDMP)

Missouri is the last state in the nation without a PDMP, and Senator Holly Rehder tried for years to get PDMP passed during her time in the Missouri House. During her first year as a Missouri Senator, she was able to get PDMP across the finish line. Upon Governor Parson’s signature, Senate Bill 63 will establish the Joint Oversight Task Force of Prescription Drug Monitoring. This Task Force would be housed within the Missouri Office of Administration and would be responsible for contracting with a vendor to create a statewide PDMP.

Public Health Limitations

In a local government transparency bill, the Missouri General Assembly aims to limit local public health orders and ban vaccine passports. House Bill 271 caps restrictions at 30 days in a 180-day period during a state of emergency, and extension for an additional 30 days must be approved by a simple majority vote of the local health authority’s governing body (e.g., county commission or city council). If a state of emergency is not in effect, the restriction length is shortened to 21 days in a 180-day period and require a two-thirds majority vote for extensions. The local governing bodies also have the authority to terminate any health order by a simple majority vote, and health departments under multiple counties would need approval from the governing body in each county. The bill bars cities, counties, towns, or villages receiving public funds from requiring documentation of a COVID-19 vaccine to access transportation of public accommodations. An emergency clause was included in the bill which means the law will go into effect as soon as Governor Parsons signs it.

Mental Health Parity

Two bills approved by the General Assembly, House Bills 604 and 432, contain language that is meant to help Missourians have access to the mental health care they need. The bills create the Mental Health Parity and Addiction Equity Act, which requires health insurers to cover mental health care in the same way they cover physical health conditions. Specifically, it requires health benefit plans to meet the requirements of the federal Mental Health Parity and Addiction Equity Act of 2008. The bill will remove hurdles that have made it more difficult for Missourians to see medical professionals and access medications for mental health conditions.

COVID-19 Liability

In its final minutes of regular session, the Missouri Legislature passed COVID-19 liability, one of Governor Parson’s priorities for the session. The legislation would prohibit COVID-19 liability lawsuits against businesses and health care providers unless plaintiffs can prove they were exposed and sickened by COVID-19 and that the entity engaged in reckless or willful misconduct. The bill does not contain an emergency clause which means, if signed, the law will not take effect until August 28, 2021.

Wayfair Sales Tax

The Wayfair Sales Tax refers to a sales tax imposed on online purchases made through vendors with a physical presence in the state. Missouri is one of only five states in the U.S. to not impose such a sales tax. The sales tax levels the playing field for brick-and-mortar businesses and brings additional revenue into the state. Senate Bill 153 fully implements the local use tax on internet sales. BJC has supported a Wayfair Sales Tax for several years and is pleased to see it pass out of the legislature.

Gas Tax

Senate Bill 262, unchanged from the version that was approved by the Senate, passed the Missouri House 104-52. If approved by Governor Parson, the tax would take effect in five steps of 2.5 cents each starting on October 1. The tax will be fully implemented on July 1, 2025 and would be 29.9 cents a gallon. This would add $337.5 million annually to Missouri’s road fund and $125 million for city and county governments to spend on local roads. The Missouri Independent reports that the last bill increasing the fuel tax was passed in 1992 and signed by Governor John Ashcroft, a Republican. It increased the tax by six cents a gallon in three two-cent steps.

Criminal Justice Reform

On May 13, House Bill 53 passed the Missouri Senate and now awaits Governor Parson’s signature. The bill prohibits the use of police respiratory chokeholds unless deadly force is authorized. A “respiratory chokehold” includes the use of any object or body part to attempt to control or disable a person by applying pressure to the person’s neck with the purpose, intent, or effect of controlling or restricting the person’s breathing. The bill clarifies that it is unlawful for law enforcement to engage in sexual conduct with a detainee or prisoner, confirms that 17-year-old individuals are classified as juveniles, and improves police background checks. The measure requires jails and prisons to provide women in custody disposable menstrual products. It also ends the Kansas City Police Department’s residency requirement. Proponents feel this bill is a strong step forward toward more criminal justice reform.

Firearms (Second Amendment Preservation Act)

House Bill 85 creates the Second Amendment Preservation Act (SAPA) and prohibits the enforcement of federal gun laws by local police. Departments with police who knowingly enforce federal gun laws would be fined up to $50,000. SAPA would nullify any federal law that restricts gun ownership, including those related to taxes, tracking, confiscation orders, and prohibitions on possession.

Federal Reimbursement Allowance (FRA) Renewal

The Missouri Legislature passed the FRA reauthorization during special session and was signed into law by Governor Parson on June 30. The General Assembly failed to reauthorize the provider taxes during regular session due to efforts to include language that would limit contraception and prohibit certain providers from Medicaid. The reauthorization is through September 30, 2024, and it does not include any undesirable language.

MO HealthNet

Effective July 1, 2021, the Missouri HealthNet Division implemented a new outpatient payment policy. The previous payment methodology was primarily based on a percent of the hospital’s billed charges. The new method of paying for outpatient hospital services uses a simplified fee schedule based on Medicare’s Ambulatory Payment Classifications. The fee schedule is for all outpatient services.

BJC submitted a comment letter as the Department of Social Services (DSS) is accepting comments for 30-days post-publication of the proposed rule. A comment letter was submitted earlier this year when DSS accepted comments as part of the federally mandated public notice issued April 5.

Governor Parson announced Donald Kauerauf as the new Director of the Missouri Department of Health and Senior Services, effective September 1, 2021. He served as the Assistant Director of the Illinois Department of Public Health from 2016 until his retirement in 2018. More recently, he was selected to Chair the Illinois Terrorism Taskforce and has served in that capacity throughout the COVID-19 pandemic.

Page updated 08/25/2021