Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · Missouri

Medicaid work requirements in Missouri: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

Missouri expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 327,567 of them (9.0% of an expansion pool of 350,174) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 164,291 people in Missouri lose coverage by 2034: 154,464 of them still eligible but lost to paperwork and reporting failures, and 9,827 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. Missouri scores 67 of 100 on this model's ex parte capability index, a mid band; its eligibility system is FAMIS.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureMissouri
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)350,174
Adults subject, strict definition327,567
Adults subject, permissive definition321,016
Share of expansion pool subject9.0%
Projected coverage loss by 2034164,291
Hardship exception statusNot adopting
Early implementerNo
Ex parte capability score (0 to 100)67 (mid)

Who is subject in Missouri

Of the 327,567 subject adults, 35% already work 80 or more hours a month and 58% are not working. 38% have a child under 14 at home. Among those not working, 60% report a disability and 15% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2412%
Age 25-3422%
Age 35-4422%
Age 45-5418%
Age 55-6426%
Not working58%
1 to 19 hours a month0%
20 to 79 hours a month6%
80 or more hours a month (meets the bar)35%
Not working: Disabled60%
Not working: Caregiver15%
Not working: Postpartum0%
Not working: Student2%
Not working: Other24%

Why eligible people lose coverage

Of the 164,291 projected to lose coverage in Missouri, 154,464 meet the requirement or qualify for an exemption but fail to document it. 54,042 of those are working people who cannot prove their hours through data the state can see, and 100,422 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Variable shifts / on-call work14,574
Multiple part-time jobs (aggregation failure)10,566
Full-time students not auto-verified9,567
Self-employed (other)8,674
Cash-paid construction & trades3,638
Volunteering / job training3,624
Seasonal: agriculture, hospitality, food service2,133
Gig / courier (DoorDash, Uber, Lyft, Instacart)1,264
Medically frail without auto-match42,714
Parent caregivers of children ≤13 without auto-match17,969
Caregivers of a disabled adult14,921
SUD treatment not flagged in claims data6,511
American Indian / Alaska Native (tribal exemption)6,293
Kinship caregivers (non-parent) of children ≤135,373
Recent incarceration (data-match gap)3,544
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)2,819
Pregnancy / postpartum data lag279

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (84% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. Missouri's composite score is 67 (mid band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite67
Observed ex parte84
Core capability18
Data sources50
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four102,78031.4%
Medically frail69,00421.1%
Working ≥ qualifying hours / income + Parent caregiver of child ≤1353,61616.4%
Working ≥ qualifying hours / income44,86513.7%
Parent caregiver of child ≤1325,7847.9%
Full-time student7,3312.2%
Working ≥ qualifying hours / income + Full-time student6,0581.8%
Working ≥ qualifying hours / income + Medically frail5,4101.7%

Counties in Missouri

Subject adults concentrate: St. Louis County (52,337), Jackson County (35,739), and St. Charles County (22,078) account for 34% of the state's subject population.

All 115 counties in Missouri with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
St. Louis County52,3379.1%26,24910.0%574,238
Jackson County35,7398.3%17,92514.0%429,839
St. Charles County22,0789.0%11,0735.0%246,060
Greene County16,7039.1%8,37715.0%183,606
St. Louis city13,1737.0%6,60720.0%187,572
Clay County12,6848.2%6,3618.0%155,156
Jefferson County11,9218.7%5,9798.0%137,324
Boone County11,0859.3%5,56018.0%119,692
Jasper County6,3868.9%3,20318.0%72,040
Cass County5,8339.2%2,9257.0%63,676
Franklin County5,7349.4%2,8768.0%60,886
Platte County5,6418.6%2,8297.0%65,996
Christian County4,7098.9%2,3629.0%53,084
Cape Girardeau County4,6879.6%2,35115.0%48,739
Buchanan County4,4159.0%2,21417.0%49,183
Cole County3,9378.7%1,9749.0%45,146
Newton County3,37710.0%1,69415.0%33,704
St. Francois County3,3338.2%1,67218.0%40,698
Taney County3,31810.7%1,66416.0%31,044
Lincoln County3,2088.6%1,60912.0%37,226
Phelps County3,06211.4%1,53618.0%26,912
Johnson County3,0118.8%1,51012.0%34,137
Camden County2,79612.3%1,40213.0%22,823
Callaway County2,3248.7%1,1669.0%26,771
Pettis County2,2609.3%1,13315.0%24,428
Pulaski County2,2456.6%1,12615.0%34,184
Webster County2,1959.8%1,10116.0%22,490
Stone County2,13113.2%1,06914.0%16,180
Howell County2,1189.6%1,06223.0%22,154
Butler County2,0808.8%1,04321.0%23,534
Warren County2,0779.7%1,04210.0%21,419
Barry County2,07210.9%1,03918.0%18,919
Lawrence County2,0679.7%1,03715.0%21,308
Scott County1,9729.3%98916.0%21,302
Laclede County1,9189.4%96217.0%20,340
Polk County1,8009.8%90317.0%18,427
Lafayette County1,7989.6%9029.0%18,756
Adair County1,67010.6%83724.0%15,732
Stoddard County1,5479.7%77616.0%16,028
Marion County1,4999.4%75214.0%15,862
Saline County1,45910.8%73213.0%13,496
Miller County1,41710.1%71016.0%14,038
Dunklin County1,3949.4%69922.0%14,904
Nodaway County1,38010.9%69219.0%12,614
Texas County1,3419.6%67220.0%13,940
Benton County1,33813.1%67118.0%10,186
Ray County1,3089.9%65612.0%13,196
Morgan County1,30011.5%65220.0%11,352
McDonald County1,2979.4%65017.0%13,721
Audrain County1,2909.2%64718.0%14,028
Crawford County1,2359.8%61915.0%12,658
Washington County1,2269.1%61519.0%13,501
Henry County1,1859.8%59415.0%12,116
Randolph County1,1848.2%59417.0%14,416
Clinton County1,1309.3%56711.0%12,173
Ste. Genevieve County1,06910.3%5369.0%10,425
Andrew County1,04010.3%5218.0%10,044
Perry County1,0139.4%50811.0%10,763
Vernon County1,0119.5%50718.0%10,648
Wright County9849.7%49420.0%10,106
Pike County9118.9%45716.0%10,235
Dallas County8979.4%45021.0%9,548
Cooper County8979.4%45013.0%9,585
Gasconade County87510.7%43912.0%8,161
Bates County8739.5%43819.0%9,176
Cedar County85311.2%42818.0%7,624
Macon County84610.4%42411.0%8,117
New Madrid County8139.3%40817.0%8,745
Dent County80810.2%40517.0%7,912
Osage County79010.3%3968.0%7,672
Pemiscot County7319.0%36729.0%8,097
Moniteau County7098.2%35511.0%8,674
Livingston County7098.6%35610.0%8,226
Douglas County70311.5%35320.0%6,114
Madison County6719.4%33712.0%7,138
Howard County67011.8%33613.0%5,662
Lewis County64411.4%32316.0%5,668
Barton County63710.0%31922.0%6,349
Linn County63710.0%31917.0%6,376
Wayne County62910.7%31525.0%5,890
Montgomery County6269.7%31415.0%6,467
Ralls County59710.6%29912.0%5,648
Bollinger County59410.0%29815.0%5,935
St. Clair County58811.8%29516.0%4,982
Ozark County56812.7%28522.0%4,480
Ripley County5629.6%28221.0%5,876
Mississippi County5498.0%27624.0%6,894
Hickory County54412.7%27318.0%4,272
Grundy County53110.7%26617.0%4,961
Monroe County52611.6%26416.0%4,553
Iron County5099.7%25520.0%5,270
Caldwell County50410.2%25316.0%4,922
Daviess County49811.2%25014.0%4,442
Oregon County49110.7%24623.0%4,608
DeKalb County4867.5%24410.0%6,508
Maries County47810.0%24017.0%4,762
Carroll County46910.2%2359.0%4,614
Harrison County46410.9%23316.0%4,266
Dade County45011.0%22617.0%4,106
Chariton County43211.6%21713.0%3,742
Shannon County40510.5%20315.0%3,851
Clark County37810.7%19011.0%3,535
Reynolds County33810.1%17018.0%3,350
Shelby County33410.6%16815.0%3,146
Gentry County3209.4%16115.0%3,394
Sullivan County3199.9%16015.0%3,216
Carter County30210.5%15221.0%2,866
Atchison County29810.8%14912.0%2,754
Putnam County26310.9%13212.0%2,414
Holt County25111.3%1269.0%2,212
Scotland County25110.8%1267.0%2,312
Knox County24612.5%12313.0%1,962
Schuyler County22510.7%11310.0%2,106
Mercer County20111.1%10115.0%1,818
Worth County12913.2%6517.0%980

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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