End of session update

May 14 th marked the end of Missouri’s 2021 legislative session. The Senate “truly agreed” to 26 Senate bills and 3 Senate concurrent resolutions. The House “truly agreed” to 39 House bills and 1 House joint resolution. Each of these bills are now waiting to be signed by the Governor.

Although we supported, tracked, and advocated for numerous bills to improve Black maternal and infant health, the hot topic for this year’s session became Medicaid Expansion. In August 2020, voters across the state voted in favor of expanding Medicaid, yet statewide advocates had to unite again to defend Missouri’s constitution and Missouri’s right to Medicaid Expansion. While many organizations planned on spending their time ensuring that Medicaid Expansion would roll out properly, few expected that the Missouri legislature would simply refuse to budget funds for Medicaid Expansion. Legislator’s blatant attempt to overturn the will of the voters was one of the most disgusting displays of political manipulation we have seen in recent years. With complete disregard for Missouri’s most financially vulnerable residents, legislators decided to play politics with people’s health.

Since Medicaid Expansion is in Missouri’s constitution, a legal battle has begun. Three plaintiffs, who would receive Medicaid under expansion, have filed a lawsuit against the Missouri Department of Social Services, the MO HealthNet Division, and the Family Support Division. The lawsuit states that the Department of Social Services appropriations bill does not limit MO HealthNet funding based on categories of eligibility. Therefore, if the constitution states that Medicaid coverage is now provided for a new eligibility group, the department is obligated to provide that coverage.

On June 18 th , the trial to decide the fate of Medicaid Expansion will begin.

While we don’t know what will come next, it is important to continue raising awareness about the need for expansion and the benefits to our state. Please use these talking points to continue spreading the word.

What exactly happened with Medicaid Expansion?

  • Mid-session, Representative Cody Smith (R- Jasper), the Budget Chairman, refuses to include Medicaid Expansion funds into budget appropriations and instead separates Medicaid Expansion funding into a separate bill, House Bill 20. In the Budget Committee, HB 20 was voted down, meanwhile the other budget bills were passed.
  • The Senate Appropriations Committee received the budget bills (without funding for expansion). Senator Lincoln Hough (R- Greene) proposed an Amendment to add funding for Medicaid Expansion, but it was voted down in the committee.
  • Once the budget bills made it to the Senate floor, Senate Minority Leader John Rizzo (D-Independence) added an amendment to the Department of Mental Health budget which provided funding for Medicaid Expansion, but this was also voted down by the Senate.
  • With the House and the Senate refusing to expand Medicaid, all eyes looked to the Governor. In January, Governor Parson’s budget recommendations included funding for Medicaid Expansion. However, Governor Parson withdrew his request to expand Medicaid from the Centers for Medicare and Medicaid Services, stating that the lawmakers didn’t include it in the budget.
  • Post-session, a lawsuit is filed against the Department of Social Services to ensure that Medicaid services are provided to the Medicaid Expansion population.
  • Although the legal battle has begun, the Governor could still submit a request to the Centers for Medicare and Medicaid Services to expand Medicaid. Therefore, it is important to keep advocating.


We provided testimony during hearings in support of the following legislation:

  • House Bill 20: to fully fund Medicaid Expansion
  • House Bill 627: to establish a Child Development Account program for all children born in the state of Missouri
  • House Bill 652: Expanding the WIC program to include produce from farmer’s markets
  • Senate Bill 368: to increase funding for the state’s Housing Trust Fund
  • St. Louis City’s budget hearing: We testified in support of increasing funding for the City’s Affordable Housing Trust Fund
  • We also submitted a letter to MO HealthNet, which made recommendations for additional items that should be included in the new Managed Care Organization contracts.

We provided testimony during hearings in opposition of the following legislation:

  • House Bill 217 and Senate Bill 138: work requirements for the Supplemental Nutrition Assistance Program (SNAP)
  • Senate Bill 224: work requirements for MO HealthNet
  • House Bill 726: decreasing the minimum wage

Legislative Updates

In the final weeks of session, several positive amendments were added to House Bill 432, which passed through both chambers and is waiting to be signed into law by the Governor. The amendments are listed below:

  • POLICY FOR NURSING MOTHERS (Section 160.3005) This bill requires the Department of Elementary and Secondary Education to provide accommodations to lactating employees, teachers, and students to express or breastfeed for each public school building within the district for at least a year after the birth of a child and must include at least three opportunities during a school day to express or breast-feed.
  • EXTENSION FOR SNAP UTILIZATION (Section 208.018) This bill extends the expiration on the program that allows the Supplemental Nutrition Assistance Program (SNAP) recipients to utilize local farmers' markets to August 28, 2027.
  • FARMERS' MARKET ELIGIBLE FOR WIC (Section 208.285) The bill allows the Department of Agriculture to apply for a grant under the US Department of Agriculture Women, Infants and Children (WIC) Farmers' Market Nutrition Program to allow pregnant and postpartum women to obtain food at eligible farmers’ markets.
  • FARM TO FOOD BANK PROJECT (Section 208.1060) This bill requires the Department of Social Services to submit a state plan to the U.S. Department of Agriculture for a “Farm to Food Bank Project” and to contract with any qualified food bank for the purpose of operating the project.
  • FOOD SECURITY TASK FORCE (Section 261.450) This bill establishes the “Missouri Food Security Task Force”, to be comprised of 25 members as set forth in the bill that will make recommendations to the Governor and the General Assembly before August 28th of each year.
  • WORK LEAVE FOR DOMESTIC OR SEXUAL VIOLENCE (Sections 285.625 and 285.670) This bill specifies that, any person employed by a public or private employer with at least 20 employees is entitled to unpaid leave if the person, or a family or household member, is a victim of domestic or sexual violence. Permissible reasons for taking leave include seeking medical attention, recovering from injury, obtaining victim services, obtaining counseling, participating in safety planning, and seeking legal assistance.

Renewing the federal reimbursement allowance (FRA) required to operate Missouri’s Medicaid program also became a critical issue late in the session when Senator Paul Wieland added an amendment that included language to limit birth control. This language violates federal Medicaid law, putting Missouri out of compliance and risking FRA funding, the third-largest source of revenue for the state. Attempts to pass the FRA bill without the birth control language failed and ultimately the FRA bill was not agreed upon or passed. The FRA bill must pass by September; therefore, Missouri will likely have a special session to continue the FRA debate.

Tracked bills that did not pass:

House Bill 42: Allows a child who was eligible for MO HealthNet benefits to remain eligible for benefits for 12 months after enrollment, unless the child has moved out of state or has turned 19.

House Bill 46: Requires reimbursements for certified midwives if the health carrier also already provides reimbursement for certified nurse midwives.

House Bill 47: Requires that the Pregnancy-Associated Mortality Review Board consider the role of race, ethnicity, language, poverty, literacy, and other social determinants of health in its reviews and metrics.

House Bill 217: This bill requires any individual participating in the Supplemental Nutrition Assistance Program (SNAP) to comply with the work requirements described in federal statute and regulations.

House Bill 247: is punitive legislation that reduces public benefits for families whose children do not attend school 90% of the school days in the preceding six-month period.

House Bill 426: Ensures that nuisance ordinances aren’t enforced against tenants who are victims of a crime. This is important because nuisance ordinances can be used as a tool to get “unwanted” people out of a neighborhood. People who are victims of domestic violence or victims of other crimes can be banned from neighborhoods or municipalities because they’ve had to call the police too many times.

House Bill 451: is punitive legislation that takes away SNAP benefits from parents who haven’t paid child support.

House Bill 726: Proposed overturning the state’s minimum wage increase by aligning our state minimum wage to the federal minimum wage.

House Bill 937: Requires 2 hours of cultural competency training as part of the certification and recertification of psychologists, behavioral analysts, professional counselors, marital and family counselors, and social workers.

Senate bill 28: Establishes a Child Development Account program (Missouri Education Program), which will create an automatic financial deposit into a college savings account at birth, for all babies born in the state of Missouri.

Senate Bill 82: Authorizes a tax credit, not exceeding $1,000, for the development of an urban farm located in a food desert.

Senate Bill 84: Provides a $5,000 tax credit for first time homebuyers, who meet income guidelines, and purchases a single-family home that has been “blighted.”

Senate Bill 138: This bill requires any individual participating in the Supplemental Nutrition Assistance Program (SNAP) to comply with the work requirements described in federal statute and regulations.

Senate Bill 224: would impose work requirements for MO HealthNet recipients. Participants ages 19 to 64 shall complete at least 80 hours a month of any combination of specified work, education, job search, childcare, and volunteer services.

Generate Health
5501 Delmar Blvd, #B240
St. Louis, MO 63112
phone: (314) 880-5719
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