The Missouri House has passed a proposed constitutional amendment that would make multiple changes to the state’s Medicaid program, including allowing the legislature to control funding of its expansion.

The amendment would give the legislature the power to separately appropriate funding for the Medicaid expansion program on a yearly basis.

“This would allow us to uncouple parts of the Medicaid program and prioritize them through the appropriations process in the event that we should need to,” said House Budget Chair Cody Smith, R-Carthage.

House members on Thursday voted 95-45 to pass the resolution. If the Senate agrees, it would need approval from Missouri voters in November to go into effect.

It’s a way the legislature could decide whether to fund Medicaid expansion, which it refused to do last year after Missouri voters had approved the expansion in 2020. The Missouri Supreme Court ruled in July that the ballot initiative voters approved did not violate state law, making an additional 275,000 Missourians eligible for Medicaid.

Democrats spoke against the amendment on the House floor both Thursday and earlier in the month during first-round approval, including Rep. Martha Stevens, D-Columbia, who said Republicans have not made the right decisions regarding Medicaid expansion.

“I really hope the body will do the right thing, the compassionate thing, the moral thing and the thing that's good for our budget and vote against this,” Stevens said earlier in February.

In addition to giving the General Assembly the power to not fund Medicaid expansion on an annual basis, the amendment adds other requirements to the Medicaid program.

One is a work requirement, under which participants age 19 to 64 must work 80 hours a month. According to Smith, opportunities like volunteering and education would also count toward those hours. This part of the bill also received criticism from Democrats.

“The reason for Medicaid is not to ensure people work. It's not to raise or change what they do every day, it's to make sure people are healthy,” said Rep. Sarah Unsicker, D-Shrewsbury.

The state would have to receive approval for the work requirement from the federal Department of Health and Human Services. President Joe Biden’s administration has repeatedly denied states the ability to implement work requirements.

In addition to the content of the amendment, Democrats also criticized how the bill was written, including the order that these changes are listed. An amendment to rewrite how the language would be presented to voters was defeated earlier in the month.

The amendment now goes to the Missouri Senate.

Follow Sarah Kellogg on Twitter: @sarahkkellogg

Send questions and comments about this story to feedback@stlpublicradio.org.

Got a news tip? Send it to Sarah Kellogg.