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2021 Missouri Legislative Wrap Up

2023 Missouri Legislative Wrap Up

The Missouri General Assembly adjourned for the year on May 14th, 2021. Prior to the 2021 session, the Jackson County Health Department outlined policy priorities. We take a brief look at what was accomplished this session below.


Met Policy Goal

Partially Met Policy Goal

Didn’t Meet Policy Goal


  1. Support social safety net programs through federal, state, and local funding

Avoid cuts to Temporary Assistance for Needy Families (TANF) cash benefit amount and reducing lifetime limits

While Governor Parson’s budget did not cut much needed programs for low income families, Missouri’s maximum allowable benefit has not been changed or adjusted for inflation since 1991. If Missouri’s benefit amount was adjusted for inflation, it would be $550/month today. Instead it is still $292/month.

Avoid cuts to the Unemployment Insurance (UI) benefit amount, and increase the period to 26 weeks — the standard across the country

While there were no cuts to the state UI benefit amount, Governor Parson chose to stop participating in the six federal pandemic-related unemployment programs beginning June 12, 2021.

Avoid new caps on Medicaid enrollment, cuts on provider reimbursement, and new restrictions on services covered

An important tax bill, called the Federal Reimbursement Allowance, failed to pass before the legislative session ended. This bill would have renewed the taxes paid by hospitals to help cover the state’s Medicaid program. Without it the state risks losing $1.3 billion used for the state’s Medicaid match, and close to $3 billion in federal funds for Medicaid. Without this funding, services provided under Medicaid would be severely impacted. The current funding bill sunsets in September 2021, meaning the General Assembly will need to meet in a special session to get this vital funding bill passed.

Avoid cuts to safety net programs, including childcare subsidies, and early childhood programs funding; avoid cuts to K-12 education

No cuts were made to existing programs, or to K-12 education. Funding for higher education increased in this year’s (FY22) proposed budget. Additionally, Missouri established a state-level Earned Income Tax Credit that will be worth 10% of the federal credit and will benefit an estimated 250,000 Missouri families.

  1. Preserve and support an experienced, well-funded public health workforce 

Increase or maintain funding to both DHSS and local health department programs                                                                                                                            

Governor Parson’s budget contained no significant cuts to local public health programs. However, Missouri ranks last out of all states in funding allocated to public health programs.

Allow local public health leaders and local officials – the experts on public health and on their own communities – to make the necessary and timely decisions to protect the health of their community

The Missouri Legislature passed a bill that will significantly limit local public health agencies abilities to respond to current and future public health threats. The bill will limit public health orders to a 30 day period unless extended by a majority vote from the local governing body.

  1. Prevent mental health and substance use crises, and treat mental illness and substance use

Implement a statewide Prescription Drug Monitoring Program                                                                                                          

The General Assembly has passed a bill to implement a statewide prescription drug monitoring program. Missouri was previously the only state in the country to not have such a program. The PDMP will help doctors and pharmacists to prescribe appropriate amounts of medication and reduce the risk addiction to prescription medications.

Increase mental health insurance coverage                                                                                                          

Multiple bills passed by the General Assembly this session establish Mental Health Parity in Missouri. Mental health parity prohibits insurance companies from limiting mental health benefits more stringently than medical benefits. While already a law on the federal level, states had to implement these laws at the state level to adequately enforce them. Missouri was the last state to pass this kind of legislation.

Tobacco and vaping ordinances at the local level                                                                                                                                                                                                   

While most tobacco and vaping related ordinances are considered and passed at the local level in Missouri, the General Assembly considered bills this session that would have limited the ability of local governments to pass and enforce these laws. None of these bills were passed this session.

  1. Increase access to affordable healthy foods, and increase opportunities for physical activity

Create tax incentives for grocery stores, community gardens, urban farms, etc. to locate in food deserts

While bills to implement tax incentives were considered this year, they did not pass. Missouri did pass a bill that will establish a Food Insecurity Task Force. The task force will consider if such incentives will help with food insecurity in Missouri. The bill also included a measure to create a program to provide vouchers to WIC participants to use at participating farmers’ markets, and extended an existing similar program for seniors.

  1. Improve access to primary and specialty healthcare, including oral and behavioral healthcare

Ensure Medicaid Expansion is fully funded and implemented by July 1, 2021                                                                                                          

The Missouri Legislature did not include funding for the expanded Medicaid population in any of its budget bills this year. As a result, Governor Parson rescinded the state’s State Plan Amendment to the Centers for Medicare and Medicaid Services. Missouri residents voted to expand Medicaid under the Affordable Care Act in August, 2020. A lawsuit was filed on May 20, 2021, challenging the state’s refusal to implement Medicaid Expansion despite sufficient funds. The trial has been set to start on June 18th, 2021.

Prohibit work requirements or other unnecessary or burdensome requirements for Medicaid recipients

While such legislation was considered, nothing passed this session.

Ensure convenient enrollment in MO Health Net, ACA Marketplace, and CHIP insurance plans and ensure continuous enrollment

The current refusal to implement Medicaid expansion could cause unnecessary delays in enrolling newly eligible individuals and prevent them from receiving much needed benefits. Approximately 275,000 Missourians became eligible for Medicaid with the passage of Medicaid expansion. Further delays in implementing Medicaid expansion only prevents these Missourians from accessing the care they need.

The governor has until June 28th, 2021 to sign all bills that have been passed by the Missouri General Assembly, and is expected to do so. For more about Jackson County Health Department’s policy priorities, especially on the local level, see our full 2021 Policy Agenda.