The good, the bad and the almost: A review of the 2018 legislative sessions in Missouri and Kansas

Health Forward focuses on igniting a culture of health by advocating for health and wellness and working to ensure that the health of those most in need is prioritized by our elected leaders.

Health Forward’s policy agenda helps guide the ways that Health Forward uses its own voice in support of policy change, but it’s worth noting that our grantmaking dollars support policy changes that aren’t captured on this agenda.

As legislative sessions in Kansas and Missouri both wind to an end, here’s an update on some of the health issues we watched closely throughout the year.

Three great things that happened:

Missouri took the first step to improve infrastructure for MO HealthNet

The IT system that powers Missouri’s Medicaid system — including billing and payment functions and integration with those using the system — is old and broken, leaving the state unable to efficiently operate its Medicaid program. HB 2010 included $472,000 with seven full-time employees to begin the process of developing new Medicaid infrastructure. This is an important first step to updating the state’s crumbling Medicaid system.

The Senior Farmers Market Nutrition Program persisted!

This bipartisan and beloved bill made it so close to passing multiples times in recent years. Well, it finally crossed the finish line this session as one of the last bills taken up and passed by the Senate. HB 1625 and Senate companion bill SB 787 will establish the Missouri Senior Farmers Market Nutrition Program to provide low-income seniors with fresh, Missouri-grown produce. Big kudos to Health Forward’s many partners who fought hard for this one!

The Missouri legislature acted on the opioid problem.

A theme across health bills that gained traction this year in the Missouri General Assembly was that many dealt with opioid addiction. You can catch up on this issue with our handy and recently-released infographic. Specific strategies to combat opioids in Missouri included:

  • Postpartum Substance Abuse Treatment Coverage: After four, bipartisan lawmakers proposed similar bills to expand MO HealthNet access for postpartum women, the bills were combined (HBs 2280, 2120, 1468, 1616) and passed along with necessary appropriations. The final version of the bill allows pregnant women receiving substance abuse treatment within 60 days of giving birth to be eligible for MO HealthNet benefits only for substance abuse treatment and mental health treatment for substance abuse. The extension of benefits lasts up to 12 additional months, as long as the woman is enrolled in treatment. The provisions of the bill are pending a federal waiver. This year, the legislature created a line item for this initiative and funded ­­­it with $500,000 from General Revenue for a total of $1.4 million, including the federal match.
  • Other Opioid Efforts: The Missouri General Assembly passed Senate Bills 718, 826, and 951. Collectively, these bills:
    • Declare 2018 to 2028 the “Show-me Freedom from Opioid Addiction Decade.”
    • Establish a Drug Take-Back program that accepts unused controlled substances through collection receptacles, drug disposal boxes, etc. The act requires the Department of Health and Senior Services to develop an education and awareness program about drug disposal.
    • Create the “Improved Access to Treatment for Opioid Addictions Program,” which will disseminate information and best practices regarding opioid addiction, subject to appropriations.
    • Institute limits on certain initial prescriptions of opioid controlled substances to no more than a seven-day supply for the treatment of acute pain. If, in the practitioner’s medical judgment, more is required for treatment, the practitioner may issue a prescription for the necessary quantity after providing an explanation in the patient’s medical record. The provisions do not apply to cancer patients, hospice or palliative care, long-term care facilities, or those receiving substance abuse treatment.

Crisis Averted:

Work requirements

Efforts to impose work requirements on multiple social welfare programs in Missouri and Kansas were framed by consumer health advocates as “busy work” and “paperwork burdens.” Ultimately these policies would’ve caused consumers to lose health care access due to the difficulty of documenting their compliance with the work requirements. Two bills (HB 1856 and SB 948) would have added work requirements to qualify for MO HealthNet benefits had they passed. There was an even stronger push to add work requirements to SNAP eligibility (see SB 561, HB 1443, and HB 1486). Ultimately, all these bills were stopped in the Missouri Senate.

In Kansas, the administration proposed “KanCare 2.0,” which would have imposed work requirements and lifetime limits on coverage for some KanCare enrollees, creating additional administrative challenges and costs and resulting in fewer Kansans with coverage. A coalition of health advocates joined forces to educate legislators and the public about the potential damage caused by imposing work requirements and time limits.

Although only about 9,000 KanCare enrollees – parents with children ages 6 and older – would have been subject to the requirements, many more would have been swept up by the administrative barriers and documentation requirements and would have slipped through the cracks and lost coverage. There was also doubt about the state’s ability to effectively administer these requirements. As a result, the legislature passed a budget proviso that limits the administration’s ability to make substantive changes to Medicaid eligibility requirements without the consent of the legislature. This effectively ends the administration’s efforts to implement KanCare 2.0.

Global Medicaid waiver

SB 652 would have created a global waiver for the MO HealthNet program, similar to many of the block grant proposals contained in some of the summer 2017 “repeal and replace” efforts. Fortunately, it made no progress this year.

Better luck next year:

KanCare expansion

This huge policy win was oh-so-close to passing last year when expansion legislation passed both the House and Senate only to be vetoed by then-Governor Brownback. An attempt to override the veto narrowly failed. This session, KanCare expansion received a hearing in front of the Senate Public Health and Welfare Committee in February. The public and advocate support for KanCare expansion was astounding with more than 140 supporters submitting testimony in favor. The bill easily passed the committee. However, Senate leadership blocked the measure, denying a floor debate and vote. The 2018 legislative session ended without progress.

Advocacy in your community

We at Health Forward are so grateful to be part of such a vibrant effort to create systems and policies that provide our neediest residents with the greatest chance of living a healthy life. We know many of you are joining us on this journey and identifying issues and advocating for change each and every day.

Please use the comments section below to share any recent policy wins and losses. This overview reflects just a snippet of the many things happening around health in our states, and we would love to hear more about the issues that are rising to the top in your community.


Health Forward Foundation
2300 Main Street, Suite 304
Kansas City, MO 64108
(816) 241-7006