The biggest changes in Medicaid's history are still five months away, but legislators, medical policy advocates, and other organizations that work with people enrolled in the public marketplace worry Missourians aren't prepared.
"We don't want anyone to have to go to the pharmacy and find out they can't get their medicine," Jackson County Legislature chair Donna Peyton told a crowd Wednesday at Hickman Mills Real-World Learning Center, in south Kansas City.
Starting Jan. 1, all Medicaid enrollees will need to prove their eligibility for the healthcare program every 6 months, instead of every year. Adults seeking benefits must also work or volunteer 80 hours per month, be enrolled part-time in an education program or have a medical condition that prevents them from working.
"We don't want anyone to drop off and have to recertify," she said.
Peyton was joined by staff from Children's Mercy Hospital to discuss what these changes mean, who will be most impacted, and when people should be ready for the new policies. It was the second town hall hosted by LINC, with more planned before the new Medicaid provisions, passed as part of President Donald Trump's One Big Beautiful Bill Act, go into effect.
She's also been working with local faith leaders to inform her community, and Peyton said she's now "deputizing" people who have heard the news..
"These are the biggest cuts in the history of Medicaid — a program that started in Jackson County and was signed into law at the Truman Library in 1965," said Connor Stangler, the Children's Health policy program director at Children's Mercy. "And this is where the changes are going to be felt."
Missouri is already seeing a drop-off in enrollment. Between January 2025 and May 2026, the state saw about a 5% drop, according to Missouri Department of Social Services data.
Stangler can't be sure what's behind the drop, but he suggested it could be coming from the children of immigrants. Starting Oct. 1, Medicaid eligibility will be limited to lawful permanent residents, which means even asylum-seekers will lose coverage.
"Some of the speculation is that there is already kind of a chilling effect for immigrant populations happening right now, in anticipation," Stangler said, adding parents might not realize their children who are citizens are still eligible.
Joan Aker, executive director of the Center for Children and Families at the Georgetown McCourt School of Public Policy, suggested in her blog that mixed-status families might also be too fearful of deportation or other negative consequences if they share contact information.
New requirements
Among the broader population, adults aged 16 to 64 who qualify for Medicaid coverage on income alone are the most likely to face issues.
In Missouri, enrollees will need to prove they've attended 80 hours of work, school, or community service — Stangler called it "community engagement" — during at least one month of the previous 6-month review period. And new enrollees will need to prove they meet this requirement one month before enrollment, which is more lenient than in some other states.
"We were a little terrified that they were going to say three months, because some states can do that," Stangler said. "Indiana is, in fact, doing that."
Nebraska, Montana, and Arkansas plan to enact the requirements early, according to KFF.
There are some exemptions to the federal work requirement, which include:
- pregnant women,
- people enrolled in rehab,
- parents or caretakers of a child under 14,
- caretakers of disabled individuals, and
- people with disabilities or who are deemed medically frail.
But a diagnosis isn't necessarily enough to qualify, Stangler warned.
"You will need to provide proof and documentation," he said. "A lot of this, unfortunately, might fall on providers to prove their (patients') eligibility."
According to Missouri DHSS, to qualify for an exemption, the medical condition in question must "greatly limit your ability to work, study, train, volunteer, or take part in a work program."
Stangler worries the list of conditions that will meet this criteria will be short, but expects further guidance from the state in the coming months.
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