This fall, Missourians will vote on whether to join nearly every other state in implementing Medicaid expansion. Polls indicate that expansion will pass with a large majority. In total, Medicaid expansion would provide health insurance coverage to over 200,000 Missourians and bring in over $1 billion of new federal dollars annually for the state. With expansion likely, some Missouri legislators who have always opposed expansion for ideological reasons are proposing a complex set of bureaucratic hurdles and reporting requirements for “work and community engagement” for people to participate in expansion. These reporting requirements include new obligations for state residents enrolled in Medicaid to submit forms documenting both employment status and other so-called community engagement activities. But the evidence from other states is clear: Implementing these types of requirements will be very costly to state taxpayers and will mire Missouri in years of litigation. Click the “download” button below to view the analysis.