- DSS H.R.1 Overview
DSS H.R.1 Overview
DSS is providing a proactive briefing to ensure transparency and alignment with the Missouri General Assembly on H.R.1 Implementation.
H.R.1, also known as the “One Big Beautiful Bill Act,” enacts significant changes to Medicaid and other programs that directly affect state health and social services systems. The healthcare provisions emphasize eligibility enforcement, work requirements, cost control, and administrative oversight. The legislation, which was signed into law on July 4, 2025, is designed to improve how social services are delivered to children, families, and communities. It includes provisions that strengthen program integrity, enhance efficiency, and create greater accountability.
- Key Provisions
Key Provisions
The legislation includes specific statutory mandates and deadlines that guide implementation planning.
Programs
- Medicaid (MO HealthNet)
- Supplemental Nutrition Assistance Program (SNAP)
- Rural Health Transformation Program
Types of Changes
- Eligibility Guidelines
- Program Integrity
- State & Federal Financing Arrangements
- Implementation Timeline
Implementation Timeline
DSS has developed a phased, high-level timeline to meet legislative requirements while maintaining program continuity.
July 4, 2025
- Restriction on Funding to Certain Family Planning Providers
- Freeze on New Medicaid State Directed Payments
- Freeze on Current Provider Tax Rates
September 2025
- Elimination of Funding for SNAP-Ed
November 2025
- Some Non-Citizens Removed from SNAP Eligibility
December 2025
- Rural Health Transformation Program
October 2026
- Reduction in SNAP Administrative Federal Match
- Some Non-Citizens Removed from Medicaid Eligibility
December 2026
- Medicaid Work Requirements for Adult Expansion Population
- Eligibility Redeterminations Twice Annually for Adult Expansion Population
January 2027
- Limitations of Medicaid Retroactive Coverage
October 2027
- SNAP State Share Requirement
October 2028
- Medicaid Co-Pay Requirements for Adult Expansion Population
October 2029
- State Residency Data Verification for Medicaid
- Expanded Definition of Medicaid Payment Error Rate
* Note: This timeline does not Include all provisions from H.R.1.
- SNAP in Missouri
SNAP in Missouri
The Supplemental Nutrition Assistance Program (SNAP) offers a monthly benefit to help Missourians buy food and food products, such as seeds and plants to grow food. This monthly benefit is loaded to an Electronic Benefit Transfer (EBT) card and cannot be withdrawn as cash. The monthly benefit amount depends on income and household size.
Eligibility
- Be a Missouri Citizen
- Have a Social Security Number
- Make Less than the Income Limit
- Own Less than $3,000 in Resources
SNAP Recipients
There are 642,563 Missourians receiving SNAP benefits in November 2025.
Average Monthly SNAP Benefit
The average monthly SNAP Benefit per individual is $402.
Income Limits
SNAP Income Limits are 130% of the Federal Poverty Level.
For an Individual Living Alone:
- Gross Income $20,352
- Net Income $15,660
For a Family of Four:
- Gross Income $41,796
- Net Income $32,160
- Medicaid in Missouri (MO HealthNet)
Medicaid in Missouri (MO HealthNet)
Missourians who do not have health insurance or need help paying for health care, may be eligible for coverage through Missouri’s Medicaid program, called MO HealthNet.
Eligibility
Eligibility for MO HealthNet depends on income, age, health, and individual needs.
MAGI (Modified Adjusted Gross Income) and Non-MAGI are two different ways MO HealthNet determines eligibility, with MAGI focusing on household income (like tax returns) for younger adults, children, and pregnant women, while non-MAGI looks at income and countable assets/resources (like bank accounts) for seniors (65+), blind, and disabled individuals.
- Be a Missouri Citizen
- Have a Social Security Number
- Make Less than the Income Limit
- Not Own Resources Over the Resource Limit
If they meet the eligibility requirements, Missourians may receive MO HealthNet coverage if they are a:
- Senior (age 65 and older)
- Parent or caretaker with a child (under age 19)
- Child (age birth -18)
- Woman (age 18-55) with no health insurance
- Adult (age 19-64) without disabilities
- Pregnant woman (including unborn child)
- Woman (under age 65) with breast or cervical cancer
- Person with disabilities
- Blind or visually impaired adult
Individuals Enrolled in MO HealthNet
There are 1,262,320 Missourians receiving MO HealthNet coverage in December 2025.
MO HealthNet Adult Expansion Group (AEG) Enrollees
There are 348,555 Missourians in the Adult Expansion Group receiving MO HealthNet coverage as of January 2026.
Income Limits
AEG Income Limits are 133% of the Federal Poverty Level.
Individual Living Alone: $20,814
Family of Four: $42,759
- Eligibility Determinations
Eligibility Determinations
- Family Support Division (FSD) Call Center and Local Offices
- Contracted Partners
- MAGI vs. Non-MAGI
- Missouri Eligibility Determination and Enrollment System (MEDES) vs. Family Assistance Management Information Systems (FAMIS)
- SNAP Eligibility Changes
SNAP Eligibility Changes
ABAWD (Able-Bodied Adult Without Dependents) Work Requirement Changes:
There are work requirements for individuals aged 18 - 64, unless exempt or excluded.
- Some individuals who were formerly exempt from work requirements will no longer be automatically exempt, including the following:
- Veterans
- Homeless Individuals
- Former foster care individuals aged 24 and younger who were in foster care at the age of 18
- Additionally, some individuals were exempt from the work requirements based on having a dependent under 18 years of age in the home. This dependent age limit is changing to under 14 years of age.
- There are exceptions added for Indians, Urban Indians, and California Indians.
Implementation Date: Upon enactment and appropriate FNS guidance
Citizenship Changes:
SNAP citizenship requirements only include US citizens and nationals, Lawful Permanent Residents, Cuban and Haitian Entrants, and COFA residents. Refugees, qualified immigrants, and asylees can no longer receive SNAP benefits.
Effective: November 1, 2025
Utility Allowance Changes:
The Standard Utility Allowance (SUA) applied when calculating SNAP eligibility and benefits for all households receiving the Low-Income Home Energy Assistance, Energy Assistance (EA) program benefits in the last 12 months, changed to only being allowed for Elderly and Disabled households. This deduction is $495 per month.
Implementation Date: Upon enactment and appropriate FNS guidance
- Some individuals who were formerly exempt from work requirements will no longer be automatically exempt, including the following:
- Medicaid Eligibility Changes
Some non-Citizens removed from Medicaid Eligibility
Limits Medicaid and Children’s Health Insurance Program (CHIP) eligibility to lawful permanent residents, certain Cuban and Haitian entrants, and individuals from the Compacts of Free Association nations. Excludes refugees, asylees, and other humanitarian groups.
Effective: October 1, 2026
Medicaid Work Requirements for Adult Expansion Population
States must require certain expansion adults to complete 80 hours per month of work, education, or community service as a condition of eligibility. Applies to individuals ages 19-64, with limited exemptions and must be verified through ex parte processes.
Effective: Dec 31, 2026; HHS must issue rule by June 1, 2026; States may request a good faith effort extension through Dec 31, 2028
Eligibility Redeterminations Twice Annually for Adult Expansion Population
Requires Medicaid eligibility redeterminations every six months for adult expansion enrollees or those receiving Minimum Essential Coverage (MEC) through a waiver. Current 12-month requirement remains for all other populations.
Effective: Dec 31, 2026
Limitations of Medicaid Retroactive Coverage
Reduces retroactive coverage in Medicaid from up to three months to one month for expansion adults and two months for all other groups.
Effective: For applications submitted on or after Jan 1, 2027
- Program Integrity Changes
Program Integrity Changes
Medicaid
- Provider/participant verifications
- Residency, vital records
- Error rate
- Beginning October of 2029, this provision expands the federal recoupment authority for states that exceed the 3% allowable error rate.
SNAP
Error rate: Establishes that beginning in October of 2027, state agencies will be required to pay a percentage of SNAP benefit allotments if they have a SNAP Quality Control Payment Error Rate (PER) above 6%.
- Provider/participant verifications
- State & Federal Financing Changes
State & Federal Financing Changes
Medicaid
- Co-payments
- Medicaid Error Rate - Removal of good faith effort exemption
- State directed payments
- Provider taxes
SNAP
- Administrative Match
- SNAP Error Rate - State Share for Benefits
- H.R.1 Implementation
H.R.1 Implementation
FY27 H.R. 1 New Decision Items GR Federal Other Grand Total H.R. 1 Implementation (within HB11) $ 34,982,737 $ 254,123,581
$ 5,500,000
$ 294,606,318 ITSD - GR Pickup for SNAP Admin $ 2,571,064 -
-
$ 2,571,064 FMDC - GR Pickup for SNAP Admin $ 879,592 -
-
$ 879,592 Fringe (est.) - GR Pickup for SNAP Admin $ 8,100,000 -
-
$ 8,100,000 Totals $ 46,533,393 $ 254,123,581
$ 5,500,000
$ 306,156,974 FY27 H.R. 1 Reductions GR Federal Other Grand Total CRD.GV.305: Residency Requirements Savings $ (3,250,000) $ (19,500,000) -
$ (22,750,000) CRD.GV.306: Work Requirements Savings* $ (30,200,000) $ (272,208,838) -
$ (302,408,838) CRD.GV.308: Non-Citizen Requirements Savings $ (13,170,285) $ (23,866,512) -
$ (37,036,797) CRD.GV.309: Prior Period Coverage Savings $ (21,826,930) $ (118,230,099) -
$ (140,057,029) Totals $ (68,447,215) $ (433,805,449) $ 5,500,000 $ (502,252,664) FY27 H.R.1 Net Impact GR Federal Other Grand Total Totals $ (21,913,822) $ (179,681,868) $ 5,500,000 $ (196,095,690) - The Federal Mandate - Why Technology Must Change
The Federal Mandate - Why Technology Must Change
Main Goal
A mix of updating existing Missouri’s systems and creating new systems to meet new federal rules for Medicaid.
Tracking Needs
DSS’ current systems cannot automatically track these hours; we need new tools to do this work efficiently.
Strict Deadlines
Federal law requires these technology changes to be finished for most of the major tech changes by December 31, 2026.
Consequences
If the technology isn't ready, Missouri risks being out of compliance with federal law.
- Key Technology Impacts & Requirements
Key Technology Impacts & Requirements
Increased Verification Frequency
H.R. 1 requires Medicaid eligibility for the expansion population to be re-verified every six months instead of annually. This doubles the processing workload for our systems and staff.
Enhanced Data Matching
Federal law now mandates quarterly checks against the Social Security Administration’s Death Master File and monthly cross-state enrollment checks to prevent fraud.
New Community Engagement Tracking
By December 31, 2026, we must implement a new system to track and verify 80 hours of monthly work or education for approximately 300,000 expansion adults.
SNAP Accountability
New rules link state funding to "Payment Error Rates" (PER). Technology improvements are required in order to increase accuracy and reduce the risk of the state being forced to pay a percentage of benefit allotments.
- Strategic Alignment & ROI
Strategic Alignment & ROI
Focus on high-impact technology solutions that provide a clear Return on Investment (ROI) by reducing manual labor and financial risk.
Automated Eligibility Verification
By investing in platforms that supports automation, we can perform "ex parte" (automatic) renewals. This reduces the need for manual paperwork, lowers the chance of human error, and prevents a massive backlog of applications.
Fraud Prevention Via Real-Time Data
Implementing the required federal data interfaces immediately reduces "duplicate enrollment" and ensures only eligible individuals receive benefits, preserving state funds.
Virtual Assistant Technology (IVR/Chatbots)
Expanding the automated IVR systems allows Missourians to report changes and check status 24/7 without a live agent. This has already demonstrated a significant reduction in wait times and significantly improves staff efficiency in use cases that have been deployed.
System Integration
Aligning Missouri’s SNAP and Medicaid systems is critical. These technology tools help lower SNAP error rates, which directly reduces the amount of General Revenue the state must provide as a match for federal benefits.
- H.R.1 Technology Implementation
H.R.1 Technology Implementation
There are two critical technology pillars to ensure federal compliance and administrative efficiency.
Core Eligibility System Updates (MEDES & FAMIS)
- The primary eligibility systems require extensive modification to handle increased renewal frequencies and new verification protocols.
- MEDES Updates: Implement and automate the new six-month renewal cycle for expansion adults.
- FAMIS Updates: Integrate legacy systems with new federal data-sharing requirements and SNAP requirements.
- Target ROI: Automating these workflows prevents a massive manual renewal backlog that would otherwise require significant permanent staffing increases.
3rd-Party Eligibility & Community Engagement Platforms
- New federal rules mandate stricter, more frequent verification of participant income, addresses, and work hours.
- Community Engagement Platform: To build the system that tracks 80 hours of monthly work/education for ~360,000 adults.
- Income & Data Verification: Deploy real-time integrations with support verification of income and work requirements as well as duplicate enrollment checks.
- Target ROI: Leveraging real-time data sources minimizes the "Payment Error Rate" (PER). Under H.R. 1, reducing these errors prevents Missouri from being forced to pay up to 15% of SNAP benefit allotments from state General Revenue.
- The primary eligibility systems require extensive modification to handle increased renewal frequencies and new verification protocols.
- Completed Tasks
Completed Tasks
Completed
- Two formal requests for federal partners for funding to implement H.R. 1 technical requirements.
- Launched an H.R.1 Technical Response team.
- Successfully made changes in FAMIS and MEDES that were required upon enactment of the law:
- Non-Citizen
- Utility Changes
- ABAWD changes
- Completed and was awarded RHT application grant.
- Top 10 States awarded.
To Be Done
- Medicaid Work Requirements for Adult Expansion Population.
- Eligibility Redeterminations Twice Annually for Adult Expansion Population.
- Limitations of Medicaid Retroactive Coverage.
- State Residency Data Verification for Medicaid.
- How to Stay Informed
How to Stay Informed
H.R.1 Implementation Hub: mydss.mo.gov/hr1
- Rural Health Transformation Program (RHTP)
Rural Health Transformation Program (RHTP)
The legislation includes specific statutory mandates and deadlines that guide implementation planning.
- Regional Coordinating Networks and Hub Activation: Building the foundation of Regional Coordinating Networks and Local Community Hubs to coordinate local care and delivery and expand entry points for physical, behavioral, and social services
- Alternative Payment Models: Designing and launching alternative payment models to sustain ToRCH Care through rewarding collaboration and high quality and high value outcomes
- Digital Backbone: Establishing the foundational layers of technology that enable ToRCH Care to function, including platform interoperability and data modernization
- Rural Health Workforce Programs: Creating a talent pipeline that encompasses the cultivation, recruitment, training, and retention of rural clinicians and a broad array of healthcare professionals
- Provider Transformation: Investing in operational innovations that modernize and increase the sustainability of rural providers while preserving access with strategic renovations
RHTP Fast Facts
- 5 Year Grant
- $216 Million Awarded for Year 1 to State of Missouri on 12/29/25
- Revised Budget due by 1/30
- CMS has 30 days to approve
- Vision: Every rural Missourian has access to the high-quality care they need through a delivery system that is well aligned, community anchored, and built to last.
- Objectives: Expanding access to care, Improving health outcomes and Strengthening provider sustainability
- Rural Health Transformation Office will be established and housed in MHD.
- A state-regional-community Framework will be implemented to ensure consistent standards and shared infrastructure while empowering communities to design solutions tailored to their needs.
- RHTP Key Limitations & Spending Caps
RHTP Key Limitations & Spending Caps
To ensure funds are used for their intended transformative purpose, CMS has established clear rules and limitations.
Program-Specific Funding Caps
CMS has set limits on how much of a state's annual award can be spent on certain categories. These caps ensure a balanced investment across different aspects of healthcare transformation.
Spending Category Maximum Allowed Administrative Costs (State-level program management, oversight) 10% of the state's total annual award Capital Expenditures (Renovations, equipment upgrades) 20% of the state's total annual award Provider Payments (For direct healthcare services not otherwise billable) 15% of the state's total annual award Replacing an Existing Certified EHR System 5% of the state's total annual award "Rural Tech Catalyst Fund" Initiatives (Funding for health tech startups) The lesser of 10% of the annual award or $20 million Prohibited Uses
RHTP funds cannot be used for the following:
- New Construction: Building entirely new facilities is not allowed. However, funds can be used for renovations, alterations, or equipment upgrades in existing buildings.
- Supplanting Funds: The money is intended for new or expanded activities. It cannot be used to replace or substitute existing state, local, or private funding for a project that is already underway or budgeted.
- Duplicating Billable Services: Funds cannot be used to pay for clinical services that are already reimbursable through programs like Medicaid, Medicare, or private insurance. The goal is to transform care delivery, not just pay for more of the same services.
- Lobbying: Federal funds cannot be used for activities designed to influence the passage of legislation or other government actions.