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The "Big Beautiful Bill" budget battle raged on Monday night on Capitol Hill. Senators called it a 'Vote-A-Rama'.
The federal bill would cut billions of federal funding for Medicaid, leaving states that approved Medicaid expansion to pick up the bill. Missouri voted to expand benefits for Medicaid recipients in 2020.
Missouri spends about $15 billion on Medicaid per year. According to the Missouri Budget Project, the majority of that funding comes from federal dollars. Another $1.5 billion chunk comes from provider taxes. Those dollars are from hospitals and health care organizations that accept patients on Medicaid, to help Missouri pay for the program.
But under the "Big Beautiful Bill," experts from the Missouri Budget Project explained there could be a double deficit for the Missouri Medicaid budget.
"It's a pretty harsh impact for us," President and CEO Amy Blouin said. "The cuts will impact every person."
The Missouri Budget Project is a non-profit, non-partisan policy analysis group that tracks state budgets and programs. Under the bill currently making its way through the U.S. Congress, states that expanded Medicaid won't be able to increase provider tax rates.
Missouri is one of 17 states facing a federal and provider tax shortfall if the bill passes.
"Without those funds, in order to protect Medicaid, we will need to dig further into general revenue," Blouin said. "That means cuts for everything else, like schools and childcare, or we will cut Medicaid."
Because Missouri voted to expand Medicaid access in 2020, total cuts would be unconstitutional.
"Our hands are tied in some ways that other states aren't," Blouin said.
Blouin expects funding to be drawn from other state expenses, on top of potential Medicaid service reduction.
"I think we'll see a combination of cuts to Medicaid and cuts to other services," Blouin said. "It's going to affect your schools, it's going to affect your access to childcare. It's going to affect other services that people rely on every day in the state."
Missouri state leaders shared their thoughts on what federal Medicaid cuts could mean for Missouri's program and overall budget.
"I think we will have to have a supplemental," Missouri House Speaker Jon Patterson from Lee's Summit said. "It is very concerning hearing things from Washington about cuts that would affect the Medicaid program."
U.S. Senator Eric Schmitt stated in an interview with KSHB 41's Charlie Keegan last week that there would not be any cuts to beneficiaries.
"We're going to strengthen [Medicaid]," Senator Schmitt said. "Cutting out the waste and the fraud and the abuse in the system is an important thing to do."
U.S. Senator Josh Hawley is among a group of Republicans who openly opposed Medicaid cuts in the bill, even writing an op-ed in the New York Times asking lawmakers not to cut Medicaid benefits.
But over the weekend, Senator Hawley reversed his stance on the bill, noting some changes about a delay on when the cuts would go into effect and an increase in the rural hospital fund.
KSHB 41's Caitlin Knute reached out to Senator Hawley's press team on Monday, asking what changed his mind. His office declined the request for an interview and instead sent a statement.
"Missouri's Medicaid dollars will actually increase over the next four years," the statement said in part. "Any changes to our provider framework in Missouri will not take place until the next decade. That's a win for us."
Analysis from the Missouri Budget Project predicts Missouri will lose at least $3 billion of federal funding a year under the "Big Beautiful Bill," which provider taxes would not be able to make up.
