Missouri lawmakers passed a bill Wednesday to extend a series of key taxes that fund the state’s Medicaid program. This ended a months-long dispute with a group of far-right lawmakers who tried to block the extension.
The legislation, called the Federal Reimbursement Allowance (FRA), would keep the state’s Medicaid program running to provide health care coverage to about 1 million residents. Failure to renew the taxes would have resulted in a loss of billions in state and federal Medicaid funds.
The House voted 136-16 to approve the taxes, sending them to Republican Gov. Mike Parson’s desk.
“This has become an integral part of the state budget and primarily funds a large portion of our Medicaid program,” said Rep. Cody Smith, a Carthage Republican who chairs the House Budget Committee.
The bill’s passage comes after the far-right Senate Missouri Freedom Caucus spent 41 hours blocking the extension until a laundry list of their demands were met, including Parson’s signature on a bill that would ban Medicaid funds from going to Planned Parenthood.
The Freedom Caucus ended their filibuster before Parson signed the legislation. However, Parson ultimately signed the bill banning Planned Parenthood funding.
The FRA also lists an expiration date of 2029, which the far-right group had sought.
House Minority Leader Crystal Quade, a Springfield Democrat, blasted Freedom Caucus members for using the bill as a “hostage in terrorist negotiations.”
“I hope and ask those of you who remain that you look at this for exactly what it is, something that is essential for our state’s budget to function as a government,” said Quade, who is running for governor.
The FRA is levied on hospitals, ambulance companies and pharmacies, which have voluntarily contributed to the system since 1992. Taxes are a crucial source of financing for the entire state budget.
While the filibuster was underway in the Senate earlier this month, a chorus of Missouri health care groups and the Missouri Chamber of Commerce and Industry denounced the Freedom Caucus for blocking the measure.
Not renewing the taxes would have harmed children with chronic diseases, shuttered nursing homes, shuttered rural hospitals, collapsed mental health systems and compromised pharmacy and emergency services, the groups said.
Not renewing the taxes would have led to an estimated loss of $4.3 billion in state and federal Medicaid funds in fiscal year 2026, according to an analysis by the Missouri Budget Project, a nonprofit organization that analyzes budget policy .
The filibuster, which lasted nearly a full week, also had a lasting impact on the state budget. The budget chairs of the House of Representatives and the Senate had to negotiate the spending plan behind closed doors, preventing more formal debates on the floors of each chamber to meet the constitutional deadline.
“The process was complicated and different, quite unprecedented,” Senate President Pro Tem Caleb Rowden, a Republican from Columbia, said immediately after the budget passed the Senate last week. “I hope this doesn’t become the new norm.”
This session marked the second time in recent years that tax renewals have sparked controversy.
In 2021, lawmakers were forced into a special session after a group of far-right senators similarly demanded legislation blocking Planned Parenthood from receiving Medicaid payments.
The Star’s Kacen Bayless contributed to this story.
