The Medicaid work rule in the One Big Beautiful Bill Act excuses an expansion adult with a serious disability from the monthly hours, and the state is to spot such people from records it already holds where it can; someone the state misses must report hours, so a missed form can end coverage as surely as a missed shift. Ann Wagner, who represents Missouri's 2nd District, voted for that law on July 3, 2025, and the agency that runs Medicaid expects 2.3 million fewer enrollees in fiscal 2027 because of the rule.
In February and April 2025, Wagner's votes were the margin on the budget resolution carrying an $880 billion savings floor for the committee over Medicaid. Medicaid-funded care at home, called home and community-based services, is mostly optional for states and so more exposed when budgets tighten; 1,835 Missourians were on waiting lists for them in 2026.
Ann Wagner's Votes on Medicaid for People With Disabilities
- The Work Rule Wagner Voted For Makes Disabled Expansion Adults the State Does Not Identify Report Hours; CMS Says the Rule Cuts 2.3 Million From Medicaid. Ann Wagner voted yes on the final One Big Beautiful Bill Act on July 3, 2025, and it passed 218 to 214. Back on May 22, the House version had squeaked by with 215 yeas, hers included, to 214. Every covered adult owes the state 80 documented hours a month at work or comparable activity; the exemptions cover people who are blind or disabled under federal disability rules, people with a disabling mental disorder, and a person "with a physical, intellectual or developmental disability that significantly impairs their ability to perform 1 or more activities of daily living," and the law has states identify exempt people from data they already hold where possible. In its rule carrying out the law, the Centers for Medicare and Medicaid Services projects that "enrollment would be reduced by 2.3 million individuals in FY 2027," a total that includes people who qualify for an exemption but cannot get it confirmed in time.
- Wagner's Two Deciding Budget Votes Gave the Medicaid Committee an $880 Billion Savings Floor, Putting Optional Home Care at Risk. Wagner said yes to H.Con.Res. 14 twice: at adoption, 217 to 215, on February 25, 2025, and at concurrence with the Senate's changes, 216 to 214, on April 10, 2025. Each margin was small enough that her switch alone would have tied the vote and sunk the resolution. It ordered the Energy and Commerce Committee to "reduce the deficit by not less than $880,000,000,000" across ten years. Home and community-based services are "largely an optional Medicaid benefit," the Bipartisan Policy Center explains, which leaves them "more vulnerable to reductions during periods of state or federal budget constraints," and experts it cites expect the law to "slow or reverse recent HCBS expansion efforts."
What Ann Wagner's Votes Mean for Missourians With Disabilities
- Medicaid covers 7,200 disabled residents of Missouri's 2nd District, and the law shrinks the state's share. KFF counts 7,200 Medicaid enrollees with disabilities in Missouri's 2nd District in 2025, out of 75,500 enrollees there. Medicaid pays for the wheelchairs, therapy, personal-care aides and medications they use, and the law takes $14.3 billion, by KFF's estimate, from what Washington sends Missouri for Medicaid this decade.
- 1,835 Missourians wait for Medicaid home care that budget pressure makes harder to expand. Missouri had 1,835 people on its Medicaid home and community-based services waiting lists in KFF's 2026 tally. Each name is someone, often an adult with an intellectual or physical disability, waiting for an aide or day program that lets them live outside an institution; with less federal money, the state has fewer slots to open.
- Disabled expansion adults in Missouri whom the state does not identify as exempt will have to report hours or risk coverage. Because Missouri adopted Medicaid expansion, its 24,400 expansion adults in the 2nd District will fall under the work rule. Someone whose disability limits daily activities but whom the state's records do not show as exempt will have to get the exemption recognized, or report 80 hours a month, to keep the coverage that pays for care.
- 181,296 Missourians on Social Security disability live in a state KFF expects to lose $14.3 billion in Medicaid funds. In December 2024, 181,296 Missourians drew Social Security as disabled workers by the agency's count, 14,287 of them in Missouri's 2nd District; disabled Missourians who rely on Medicaid for care the benefit does not cover face the law's $14.3 billion cut to the state's federal Medicaid funding, as KFF allocates it.
Frequently Asked Questions About Ann Wagner on Disability rights
What is Ann Wagner's record on disability rights under Trump?
Ann Wagner voted for the One Big Beautiful Bill Act in 2025, after supplying one of the votes its House version needed; its Medicaid work rule exempts expansion adults with serious disabilities, though one the state does not identify as exempt must report hours, and CMS expects the rule to reduce enrollment by 2.3 million in fiscal 2027. Wagner also cast deciding votes for the budget resolution that told Energy and Commerce, which handles Medicaid, to produce no less than $880 billion in savings, and the cuts that followed put optional home care for disabled people at risk. In Missouri, 1,835 people were already waiting for that care in 2026.
If a Missourian has a disability, how does the exemption in the Medicaid work rule Ann Wagner voted for work?
Ann Wagner voted for a law that exempts a Missouri expansion adult who is "blind or disabled" or whose disability makes everyday tasks like dressing or eating hard to do alone, or who has a disabling mental disorder, and the state is to identify those people from data it already holds where possible; eligibility is reviewed "once every 6 months." Someone the state does not identify as exempt has to report 80 hours a month or risk losing coverage.
What do Ann Wagner's budget votes mean for a disabled Missourian waiting for home care?
Ann Wagner cast deciding votes in 2025 for the budget plan that set the Medicaid committee a savings target of at least $880 billion, and the law she voted for on July 3 takes $14.3 billion from Missouri's federal Medicaid funding, by KFF's estimate. Home care for people with disabilities is optional for states, which the Bipartisan Policy Center says makes it more exposed when budgets tighten, so a Missourian among the 1,835 on the state's waiting lists faces a longer wait for an aide or day program.
Last updated: 2026-10-27