SPECIAL FEATURE

The 2024 Missouri Legislative Session: Your breakdown! 

Cassie E. Brown, Executive Director and NASW-MO Lobbying Team at Winton Policy Group

Greetings Colleagues! I wanted to give you a thorough breakdown of some of the Missouri legislative session relevant to social workers. Please know that none of our successes are possible without our members! Your membership supports all of our efforts. Your outreach matters as well. I encourage you to read this summary carefully. (Yes, it is long.) Reach out with any questions!

Overview and Basic Dynamics of the Session:

Something you will notice in this breakdown. Fewer bills overall. The 2024 legislative session, which adjourned on May 17, was a historically unproductive year. Of the 2,547 bills and resolutions introduced (863 in the Senate and 1,684 in the House), 46 pieces of legislation passed, including the 18 bills that comprise the operating budget.Only 28 non-budget bills and resolutions passed this year. This is even lower than the 31 bills passed in 2020 when session was interrupted by COVID-19.Much of this was due to Senate gridlock; the chamber was unable to pass any bills during the final week, which is when the bulk of legislation advances to the Governor’s desk in an ordinary session.

The 2024 session also saw two record-setting filibusters by members of both parties, and this is the first year in living memory without any conference committees to work out differences between House and Senate versions of bills.

This was a very contentious and dysfunctional year, especially in the Senate, marked by gridlock.

NASW-MO had important successes this session. We worked closely with coalition partners, such as MOPA and MMHCA in both opposing and supporting bills of importance to the social work profession.:

NASW-MO supported the following bills which DID PASS.

• Blair’s Law – Criminalizes celebratory gunfire by creating an offense of recklessly discharging a firearm within municipal limits.Passed on SB 754. This was a small but significant piece of gun legislation.
• Veteran Suicide – Directs the Missouri Veterans Commission and Department of Mental Health to develop recommendations on preventing veteran suicide.Passed on HB 1495 and SB 912.

• Juvenile Certification – Raises the age at which juveniles can be certified to stand trial as adults from 12-14, except for certain serious offenses.Passed on SB 754.

NASW-MO opposed the following bills which DID NOT PASS :

• DEI – The House perfected but never passed language prohibiting state departments from expending funds on DEI-related programs or initiatives.
• Do No Harm – The Do No Harm Act, which curtails the use of DEI-related concepts in healthcare education programs, was heard in the House General Laws Committee but never received a vote.
• Expanding Exemptions for Providers to Opting Out of Transgender Care—NASW-MO Executive Director, Cassie E. Brown, was quoted for her testimony on this bill.
• Gender Affirming Care – Removes the four-year sunset on Missouri’s statutory prohibition on puberty blockers and hormone therapy.
• Human Trafficking CEs – Language was proposed to require numerous professions to complete continuing education hours related to human trafficking, including social workers, EMTs, nurses, and police officers.This language ran into opposition in the Senate and was blocked.Language permitting licensure boards to offer or contract out for CEs also did not pass.
• Mandates on Counselors - Requires school personnel to inform a student’s parent within 24 hours if the student questions their gender identity or requests to use alternate pronouns. 

There were things we could not accomplish in this current climate. NASW-MO and our partners still see several of these as potential goals for upcoming sessions. Some of these were close at times or were filed on multiple bills.:

NASW-MO supported the following issues/bills which DID NOT PASS:

• Homeless Youth – Waives fees for homeless youth to obtain a copy of their state ID.This bill was included in several child welfare and Department of Revenue packages, but none were able to advance to the Senate floor.
• SNAP for Individuals with Felony Drug Convictions – Removes the current statutory restrictions that bar individuals with felony drug convictions from accessing SNAP benefits.
• CROWN Act – Prohibits educational institutions from discriminating against students based on hair texture or protective hairstyles. This language passed the House unanimously and advanced through a Senate committee.
• Telehealth – Codifies audio-only technologies in the definition of telehealth.Separate telehealth bills were filed to permit the use of adaptive questionnaires.
• Childcare Tax Credits – Authorizes a package of tax credits to spur investments in childcare facilities.This legislation passed the House but was once again bogged down in the Senate by members of Freedom Caucus’ demands for corresponding reductions to personal property taxes.
• MONA – Enacts the Missouri Non-Discrimination Act to prohibit discrimination based on sexual orientation or gender identity.
• Prior Authorization - Streamline the prior authorization process for healthcare providers by providing a pathway for providers and facilities to be exempt from prior authorization requirements.
• Doulas – The doula bill that moved the furthest would create a doula registration system within the Department of Health and Senior Services to facilitate insurance reimbursement.This bill was never taken up on the House floor.A more sweeping doula bill was defeated in committee after a lengthy discussion on whether doulas could be involved in abortions.
• Marriage Age – Legislation to raise the age of marriage to 18 passed the Senate 31 to 1.However, it ran into steep opposition from a group of House Republicans.The bill eventually passed committee, but it was not placed on the calendar in time to be considered on the House floor.
• Co-Pay Accumulator – Requires insurers to count payments made with patient assistance programs toward the patient’s deductible and out-of-pocket maximum.Despite positive committee votes in both Chambers, this legislation was derailed by opposition.
• Prior Authorization - Streamline the prior authorization process for healthcare providers by providing a pathway for providers and facilities to be exempt from prior authorization requirements.

There are three more very important dynamics and issues to discuss. These are interlinked.

Initiative Petition (IP) Reform

Modifying the initiative petition process has been a priority for many Republicans in response to successful ballot measures, like Medicaid Expansion. Efforts to place abortion rights on the ballot in 2024 further raised the profile of this issue.

Currently, proposed constitutional amendments are approved by a majority vote statewide.

SJR 74 would raise this threshold by requiring a statewide majority as well as a majority vote in five of Missouri's eight congressional districts (called concurrent majorities). Initially, this was paired with language derided by Democrats as "ballot candy," such as reiterating restrictions on foreign interference in elections and that only US citizens can vote. When the Senate passed SJR 74 in February, it was stripped back to only the concurrent majorities language.There was a lot of maneuvering on this bill across the entire session on this bill, and Senate Democrats held the floor in a record-setting filibuster (roughly 50 hours) to block action on this bill.

The two chambers volleyed messages back and forth in the final days, and SJR 74 ended up in the House on the last day of session.The Senate had already adjourned so their only option to advance IP changes was to pass the underlying language without provisions on citizen voting or foreign interference.No action was taken, meaning the resolution did not pass and IP changes will not appear on the ballot this year.

Planned Parenthood & the Federal Reimbursement Allowance

Federal Reimbursement Allowance: Through the FRA, Missouri levies provider taxes that are used as state match to draw down federal dollars to fund Missouri's Medicaid program. The FRA is responsible for over $4 billion of the Medicaid budget. The provider taxes would expire on September 30 unless extended in law. Senate Appropriations Chair Lincoln Hough (R-Springfield), filed SB 748 to remove the program’s sunset.

Even before the FRA was taken up for floor debate, the issue generated significant controversy.Senator Bill Eigel (R-Weldon Spring) attempted to characterize the FRA as a multi-billion tax raising healthcare costs. In advance of the FRA coming to the floor, members of the Freedom Caucus insisted they would block action on the bill until:

• The Governor signed the defund Planned Parenthood bill (see below).
• The Senate gave final approval to SJR 74, the IP reform resolution (see above).

Members of the Freedom Caucus held the floor for about 41 hours before sitting down. Neither of their demands were met before the FRA was perfected. The only change made to the bill was moving to a five-year extension (2029). SB 748 passed both chambers and awaits the Governor’s signature.

Planned Parenthood: One of the preeminent healthcare issues this session was a prohibition on any public funds being expended to abortion facilities or their affiliates.This was aimed at barring Planned Parenthood from being reimbursed by Medicaid for healthcare services.Planned Parenthood has not received Medicaid reimbursement for about two years as legal challenges have played out.

This debate became linked to extending the FRA. Senate Freedom Caucus members demanded the defunding Planned Parenthood bill as a prerequisite for action on the FRA.

HB 2634, sponsored by House Budget Chair Cody Smith (R-Carthage), passed the House and was approved by the Senate with minor changes after an 11-hour filibuster by Democrats.Governor Parson signed HB 2634 into law.

These are complex times, and we know this report is long. Thank you for reading this far.

Most of all, thank you for your support of NASW.

Additionally…

• National Policy Note: This year the Social Work Compact enacted, because enough states passed it. There are now 18 states at the date of this writing (AL, CT, GA, IA, KS, KY, LA, ME, MN, MO, NE, OH, SD, TN, UT, VA, VT, & WA). See the SW Compact site for more information.
• NASW-MO LEAD Day on March 5 at the Capitol was an exciting success. See more information about it here. We were proud to announce our new behavioral health professionals coalition with groups such as the Missouri Psychological Association (who are happy to give us credit, too! by sharing about our work together in this APA article!) and Missouri Mental Health Counselors Association. We continue to work together on these complex issues!