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JEFFERSON CITY • Advocates for low-income Missourians are decrying a plan to impose work requirements on adults who receive Medicaid.

The measure, among a number of Republican attempts to reduce state spending on welfare programs, could affect as many as 6,580 Missourians who are enrolled in the health care program for the poor.

“This is a critical issue for the people of the state of Missouri,” said Sen. Jill Schupp, D-Creve Coeur. “I have some real issues and concerns.”

In a Senate committee Wednesday, Sen. David Sater outlined his plan to require able-bodied adults between the ages of 19 and 64 to work, attend school, search for a job or volunteer at least 80 hours a month to keep their benefits.

The Cassville Republican said the proposal includes a number of exceptions allowing recipients to opt out of working, including the birth or death of a family member or in cases where people live in areas of high unemployment.

“We bent over backwards,” Sater said.

Sater said he is attempting to reduce the growth of the Medicaid program, which costs the state about $10 billion per year and accounts for about one-third of the state budget. The rising costs have sparked a planned overhaul of the program designed to save up to $1 billion annually.

If approved, the plan would save an estimated $2 million annually.

Sater also is backing a plan to require work requirements for people who receive food stamps.

“Every year, if we don’t do anything about it, it will continue to grow,” Sater said.

The legislation comes as Missouri’s Medicaid rolls are already dropping faster than in other states.

Republicans attribute the decrease of more than 71,000 enrollees over the past year to an improving economy, but Democrats say the number of new jobs doesn't match the number of people who are not receiving benefits.

Eight other states have approved similar work requirements. Kentucky’s rule is being challenged in court and Arkansas’ is being reviewed after more than 12,000 people lost their coverage when it was implemented.

St. Louis University law professor Sidney Watson told committee members that the proposal is likely to face a court challenge if it moves forward in Missouri.

In both cases, the lawsuits in the other states are against the federal Centers for Medicare & Medicaid Services, or CMS, which sets the policy and signs off on state-level waivers.

“There is an open issue of whether CMS policy is legal,” Watson said.

Lucas Caldwell-McMillian, an attorney for Legal Services of Eastern Missouri, said the Department of Social Services, which would verify whether people are working, is not equipped to deal with the increased volume of calls.

“It’s an additional stress to the Medicaid system,” Lucas said. “It’s also a stress on the budget.”

Opponents also say it could force people to seek care at emergency rooms if they lose the ability to receive preventative care.

Of the more than 81,000 adults between the ages of 19 and 64 who receive Medicaid benefits, analysts say 6,580 will fall under the work requirement.

Of those, the department estimates that 65 percent, or 4,277, of those will fail to comply.

Under Sater's food stamp legislation, as many as 40,000 Missourians could lose their benefits under the Supplemental Nutrition Assistance Program, or SNAP, if they don’t meet work requirements. That measure is awaiting a vote in the full Senate.

The Medicaid proposal is expected to be debated again next week in advance of it being discussed by the full Senate.

The legislation is Senate Bill 76.

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Kurt Erickson is a reporter for the St. Louis Post-Dispatch