By Sara Rosenbaum, Leighton Ku, Peter Shin, Jessica Sharac, Maria Velasquez

Missouri’s August 4th vote to adopt the Affordable Care Act’s (ACA’s) Medicaid expansion for low-income adults represents a historic turning point for that state’s program. Voters did not simply vote to expand Medicaid: they voted to literally embed Medicaid expansion in the state’s constitution along with a prohibition against imposing additional conditions of eligibility (such as work rules) as part of implementing reform. The expansion, expected to be fully operational by July 2021, passed with over 53 percent of the vote; Missouri now becomes the sixth state to have adopted the expansion through a voter initiative rather than the normal legislative and regulatory process by which governors and legislatures shape their state programs. 

The data note is available here.