Push to help Missourians with disabilities avoid Medicaid loss awaits governor’s action

By: - July 4, 2023 5:55 am

Representative Melanie Stinnett, R-Springfield, on the final day of the 2023 legislative session (Tim Bommel/Missouri House Communications)

A proposal to help working Missourians with disabilities access affordable health care is among the bills now awaiting action by Gov. Mike Parson.

The legislature this year approved a pair of bills that include tweaks to eligibility for the Ticket to Work Health Assurance Program, which provides health insurance through Medicaid to employed adults with disabilities.

Workers with disabilities currently need to pay a premium if their income exceeds the federal poverty level — which is around $14,000 per year for an individual. Proponents say that restriction discourages people from moving up in the workforce and making more money, for fear of losing insurance. 

“If I lose my access to Medicaid because of a job that pays a living wage, I will not have access to the Personal Attendant Support…that I need to live independently and go to work,” Sarah Schwegel, a Missourian living with a “significant disability,” testified for a February committee hearing in favor of the proposal.

“…Without a robust Ticket to Work Program, disabled people have lower incomes than they might otherwise have, limiting their economic participation,” Schwegel wrote.

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Rep. Melanie Stinnett, the Springfield Republican who sponsored one version of the legislation, told Missouri House communications that such restrictions serve to “put a cap” on the earning potential of those with disabilities — “impacting their ability to continue taking those raises or getting a new job in a new area.”

In both versions sitting on Parson’s desk, the asset limit calculation would be modified to exclude retirement accounts, as well as increase the limit to 250% of the federal poverty level, which is around $36,000. 

The first $50,000 of a spouse’s income would also be exempt from being counted toward the limit — the lack of an exemption, Stinnett said, had served to disincentivize marriage for individuals with disabilities.

Rep. Bridget Walsh Moore, a St. Louis Democrat, also advocated for these changes, pointing to the example of a friend with a disability, she said, who avoided getting married for fear of being disqualified from coverage.

She couldn’t get married because she would lose her benefits, she said, “because her boyfriend makes too much money but he can’t solely support her,” she said. 

“She could get married later this year.


The bills also include the “Missouri Employment First Act,” which contains various requirements for state agencies to support employees with disabilities.

“It’s something that’s been worked on for nearly 20 years,” Stinnett said, of the various provisions “…and I’m really happy to be a part of the team to bring it across the finish line.”

If the provisions become law, they would be effective Aug. 28.

“By the end of the year…our workforce will look entirely different, because these people can go after that promotion, apply for that new job, they can move up the ladder,” Walsh Moore said. “Now it’s worth it to go back to school and get that degree or my master’s because I’ll actually be able to get the job I want.”


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Clara Bates
Clara Bates

Clara Bates covers social services and poverty. She previously wrote for the Nevada Current, where she reported on labor violations in casinos, hurdles facing applicants for unemployment benefits and lax oversight of the funeral industry. She also wrote about vocational education for Democracy Journal. Bates is a graduate of Harvard College and a member of the Report for America Corps.