2020 Missouri Amendment 2, also known as the Medicaid Expansion Initiative, was a ballot measure to amend the Constitution of Missouri to expand Medicaid under the Affordable Care Act. The initiative was on the August 4, 2020, primary ballot and passed with 53.27% of the vote.[1] Following previous successful Medicaid expansion initiatives in other states, Republican lawmakers in Nebraska and Utah added work requirements to their states' Medicaid expansions, which supporters aimed to prevent by proposing state constitutional amendments for future Medicaid expansion initiatives. Opponents sued to prevent the initiative from being voted on, but courts ruled in the measure's favor. The measure was supported most in urban areas and opposed in rural areas. After a delay due to a lack of funding from the Missouri General Assembly and resulting litigation, the initiative was implemented in October 2021, albeit slowly. Republican lawmakers attempted to roll back the program and add a work requirement through a state constitutional amendment, which failed after the United States Supreme Court effectively prevented the implementation of one.
