Missouri Forgoes Optional Hardship Exemptions From Medicaid Work Rules
Missouri's Department of Social Services will not adopt optional federal "short-term hardship" exemptions from Medicaid work requirements, covering hospitalization, medical travel, disaster areas, and high-unemployment regions, that states may use under the federal law requiring 80-hour monthly work, school, or volunteer activity for expansion adults starting Jan. 1, 2027. The department says it will instead rely on mandatory caregiver and "medically frail" exemptions to limit bureaucratic complexity, and will verify compliance based on just one month within each six-month reporting period. Advocates, including Legal Services of Eastern Missouri and the American Cancer Society Cancer Action Network, warn the mandatory exemptions require more verification and may not cover people with short-term acute conditions like cancer treatment or hospital stays. As of Sept. 25, 344,669 Missourians were enrolled in the adult expansion group subject to the new requirements.