Missouri voters passed Amendment 2 in August 2020, expanding Medicaid to hundreds of thousands of low-income adults who previously fell in a coverage gap. The vote was 53% in favor, and after a legal challenge that went all the way to the Missouri Supreme Court, MO HealthNet expansion officially launched in October 2021. As of 2026, roughly 358,000 adults are covered under the expanded program, and the rules governing who qualifies are now written into the state constitution. Here is what that means for your eligibility, your income limits, and the significant policy changes heading into 2027.
What Amendment 2 Did
Before Amendment 2, Missouri was one of a shrinking number of states that had not expanded Medicaid under the Affordable Care Act. Adults without dependent children, regardless of how low their income was, generally could not get MO HealthNet coverage. That left a large group of working adults earning too much to qualify for traditional Medicaid but too little to afford marketplace insurance.
Amendment 2 changed that by writing Medicaid expansion directly into the Missouri Constitution. It extended coverage to adults ages 19 to 64 with incomes at or below 138% of the federal poverty level (FPL). Because the requirement is constitutional, the legislature cannot simply repeal it through a normal vote.
The Missouri Supreme Court upheld the expansion in a 7-0 ruling in July 2021, rejecting a lower court decision that had blocked implementation. Enrollment opened in October 2021, making Missouri the 38th state to expand Medicaid under the ACA.
2026 MO HealthNet Income Limits
The income thresholds below reflect 2026 federal poverty guidelines. All figures are for gross monthly income.
Expansion Adults (Ages 19 to 64)
| Household Size | Monthly Income Limit | Annual Income Limit | FPL Percentage |
|---|
| 1 | $1,799 | $21,597 | 138% FPL |
| 2 | $2,431 | $29,175 | 138% FPL |
| 3 | $3,063 | $36,757 | 138% FPL |
| 4 | $3,695 | $44,339 | 138% FPL |
| 5 | $4,327 | $51,921 | 138% FPL |
Each additional person adds approximately $632 per month.
Children (MO HealthNet for Kids)
Children ages 1 to 18 qualify at up to 150% FPL. Children under age 1 qualify at 196% FPL. The Show Me Healthy Kids program (Missouri's CHIP) extends coverage to children in families earning up to 300% FPL.
Pregnant Women
Pregnant women qualify with incomes up to 196% FPL, and coverage continues for 12 months after delivery.
Seniors and People with Disabilities
Adults 65 and older and those receiving SSI follow stricter rules. The income limit is approximately $1,109 per month for an individual, with asset limits around $6,069. Long-term care Medicaid has separate rules with higher asset thresholds for married couples.
Who Benefits from Expansion
The adults who gained coverage under Amendment 2 are primarily working-age Missourians in low-wage jobs that do not offer employer insurance. Common industries include food service, retail, construction, and home care. Many work part time or in seasonal jobs. Without expansion, they would have earned too much for traditional Medicaid but too little for ACA subsidies, landing in what is called the coverage gap.
As of 2026, more than 1.2 million Missourians are enrolled in MO HealthNet total, with expansion adults making up about 358,000 of that total.
The Funding Cliff Heading into Late 2026
One challenge that most enrollees are unaware of: Missouri's Medicaid expansion has been partially funded by reserve accounts built from temporary federal incentive dollars under the American Rescue Plan. When expansion started in 2021, Missouri received approximately $968 million in one-time federal funding. That money was set aside to cover the state's share of expansion costs.
Those reserves were holding steady at around $532 million as of early 2026. At current draw rates, analysts project the reserves could run out by late 2026 or early 2027. When that happens, Missouri will need to fund the state share of expansion costs from the general revenue budget, which creates a significant fiscal pressure on the legislature.
This is not a reason for current enrollees to panic. The expansion itself is constitutionally protected. But it does mean Missouri lawmakers face real budget decisions in 2026 and beyond about how to sustain the program.
Federal Work Requirements Starting in 2027
The most significant change coming to Missouri's Medicaid expansion population is a federal work requirement scheduled to take effect January 1, 2027. Under the One Big Beautiful Bill Act passed by Congress, adults ages 19 to 64 covered through Medicaid expansion will need to verify they are working, volunteering, or attending school for at least 80 hours per month to keep their coverage.
States will also be required to check enrollees' eligibility twice a year rather than once annually, which adds administrative burden for both the state and enrollees.
Projected Coverage Losses
Analysis from the Missouri Budget Project estimates that approximately 170,000 people in Missouri could lose Medicaid coverage after the federal rules take effect in 2027. Over the next decade, Missouri stands to lose roughly $17 billion in federal Medicaid funding under the new law.
Missouri's Legislative Response
Missouri legislators have been debating whether to also enshrine work requirements in the state constitution. The original House bill would have added them as a constitutional mandate, but the Senate version was scaled back to simply authorize the state to impose work requirements without mandating them. As of spring 2026, no final constitutional amendment had been referred to voters.
Importantly, Amendment 2 (the 2020 voter initiative) explicitly prohibits the state from imposing additional requirements on expansion adults beyond what is required for other Medicaid populations. Federal requirements, however, apply regardless of what the state constitution says.
How to Apply for MO HealthNet in 2026
You can apply through multiple channels. Online is fastest, but in-person help is available at your local Family Support Division office.
Step-by-Step Application
Step 1: Gather your documents. You will need proof of identity (state ID or passport), proof of Missouri residency (utility bill or lease), Social Security numbers for all household members, and income documentation (pay stubs, employer letter, or tax return for self-employed individuals).
Step 2: Go to the myDSS portal. Visit mydss.mo.gov and click "Apply for Benefits." Create an account if you do not have one. The online application takes about 20 to 30 minutes to complete.
Step 3: Complete the application. Enter your household information, income, and any other assistance programs you currently receive. For expansion adults, the income section is the most critical part.
Step 4: Submit and track your application. After submitting, you will receive a confirmation number. You can log back into myDSS to check the status. The state has up to 45 days to process standard applications, but most are processed in 2 to 3 weeks.
Step 5: Respond to any requests. If MO HealthNet needs additional documentation, you will receive a notice in your myDSS account or by mail. Respond quickly to avoid delays.
Step 6: Receive your MO HealthNet card. Once approved, your coverage card arrives by mail. Your start date may be backdated to the first day of the month you applied.
Other Ways to Apply
- Phone: Call the MO HealthNet Member Help Line at 1-855-373-4636, Monday through Friday, 8 a.m. to 5 p.m.
- In person: Visit your local Family Support Division (FSD) office. Find your nearest office at dss.mo.gov/fsd/fsdloc.htm.
- By mail: Download a paper application from mydss.mo.gov and mail it to your local FSD office.
If You Are Denied
If your application is denied, you have 90 days to request a fair hearing. You can request one online through myDSS or by calling the MO HealthNet member line. Common denial reasons include income above the limit, missing documentation, or a citizenship/residency issue that can often be resolved with the right paperwork.
What MO HealthNet Covers
Expansion adults receive a standard Medicaid benefit package that includes:
- Doctor visits and preventive care
- Emergency room and hospital stays
- Mental health and substance use treatment
- Prescription drugs
- Vision care (exams and eyeglasses)
- Dental care (basic services)
- Lab tests and X-rays
- Maternity care
There is no premium for most expansion enrollees. Copays are minimal, typically $1 to $3 for some services.
Renewal Requirements
MO HealthNet must be renewed annually. You will receive a renewal notice about 60 days before your coverage end date. Respond promptly. Missing a renewal deadline can result in a coverage gap even if you still qualify. Log into myDSS or call 1-855-373-4636 to complete your renewal.
Starting in 2027, federal rules will require renewals twice per year for expansion adults. This means more paperwork and more chances to accidentally lose coverage due to missed notices. Set reminders and keep your contact information updated in myDSS.
Check Your Eligibility Now
The rules are changing in 2027. If you do not have health insurance, now is the time to apply while the current eligibility rules are in place. Use the free eligibility screener at benefitsusa.org/screener to see if you qualify for MO HealthNet, CHIP, ACA marketplace plans, or other Missouri assistance programs.
For more information on all Missouri assistance programs, visit the Missouri state benefits page.
Frequently Asked Questions
What is Missouri Amendment 2?
Amendment 2 is the ballot initiative Missouri voters passed in August 2020 that expanded Medicaid eligibility to adults ages 19 to 64 earning up to 138% of the federal poverty level. It added this expansion to the Missouri Constitution, meaning the legislature cannot easily remove it.
Why do some people call it Prop 2?
Some people use "Prop 2" informally, but the measure was officially called Amendment 2. It appeared on the August 4, 2020, primary ballot as a constitutional amendment, not a proposition. Both terms refer to the same voter-approved Medicaid expansion.
When did Missouri Medicaid expansion take effect?
After a court challenge was resolved by the Missouri Supreme Court in July 2021, enrollment in the expanded MO HealthNet program opened in October 2021.
What is the income limit for Medicaid expansion in Missouri in 2026?
For a single adult, the income limit is approximately $1,799 per month or $21,597 per year, which equals 138% of the 2026 federal poverty level. For a family of four, the limit is approximately $3,695 per month or $44,339 per year.
Will I have to work to keep my MO HealthNet coverage?
Not in 2026. Federal work requirements for Medicaid expansion adults are scheduled to begin January 1, 2027. Starting then, adults ages 19 to 64 will need to document 80 hours per month of work, school, or community service to keep their coverage.
How many people in Missouri are covered by Medicaid expansion?
Approximately 358,000 adults gained coverage through Amendment 2's expansion. Total MO HealthNet enrollment across all programs is more than 1.2 million Missourians as of 2026.
Can Missouri lawmakers repeal Medicaid expansion?
Not through a simple legislative vote. Because Amendment 2 is part of the Missouri Constitution, repealing it would require either another voter ballot initiative or a constitutional convention. However, federal changes, like work requirements, can still affect how the program operates.
How do I apply for MO HealthNet?
Apply online at mydss.mo.gov, by phone at 1-855-373-4636, in person at a local Family Support Division office, or by mail using a paper application. The online portal is fastest and allows you to track your application status.
What happens if I lose my job while on MO HealthNet?
Report any income changes to MO HealthNet through myDSS or by phone. Losing a job may make you even more clearly eligible, and your benefits should continue. Failing to report changes can create issues during renewal.
Are there any costs for MO HealthNet expansion coverage?
There are no monthly premiums for most expansion adults. Some services have small copays, typically $1 to $3. There is no deductible.
