Missouri voters have spoken. They want to join 37 other states that have expanded Medicaid.

About 53% voted during Tuesday’s primary election in favor of providing Medicaid to another 230,000 low-income adults. Roughly 47% of Missouri voters opposed the ballot measure.

The outcome highlights Missouri’s urban and rural divide. Of Missouri’s 114 counties, 105 voted against expansion.

Missouri becomes 38th state to expand Medicaid

Under Amendment 2, Missouri adults could qualify for government-funded healthcare if they earn up to about $18,000 annually or roughly $36,000 for a household of four. It allows the federal government to pick up about 90% of the state’s Medicaid costs while the state covers the other 10%. Currently, the federal government pays for about 65% and the state shells out the rest of the funding.

The clash between those for and against the proposal has been largely about the way the measure would affect the state’s piggy bank and the philosophical differences. The other message Republicans have been raising is the plan also changes the Missouri Constitution to force additional people onto Medicaid. The feature effectively blocks Republican lawmakers from adding conservative elements to the program, such as work requirements and premiums.

The projected cost of the expansion has quite the range – either an additional $200 million to the state or a savings of $1 billion.

The ballot measure requires Missouri to expand Medicaid by next July and formally notify the federal government by March 1.

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