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Supporters of expanding Medicaid in Missouri are now looking to the full Senate to provide funding for the program after a key budget committee narrowly rejected a pared-down compromise late Wednesday. On a 7-7 vote, the GOP-controlled Appropriations Committee dumped a proposal to bankroll at least half of the cost of adding an estimated 275,000 more low-income adults to the government health care program known as MO HealthNet. (Erickson, 4/23)

Missouri voters last year amended the state Constitution to extend access to government health care to thousands more low-income adults, but now the Republican-led Legislature is arguing over whether to fund it. Many Republican lawmakers have for years resisted expanding access to Medicaid, citing the expense of expanding it and waste within the current program. (4/22)

The Texas House rejected an attempt Thursday to direct the governor and state health officials to use billions in federal dollars to expand health care coverage for uninsured Texans, including working poor who earn too much to qualify for Medicaid but too little to afford their own health insurance. On a vote of 80-68, lawmakers voted down the proposal, which was floated as a two-page amendment to the state budget Thursday. (Brooks Harper, 4/22)

Thursday’s defeat sets up an uncertain year ahead for state health officials, who must now begin renegotiating a deal with the Biden administration for billions of dollars to cover the cost of emergency care for uninsured Texans. Federal health officials last week threw out an eleventh-hour approval by the Trump administration for that funding — money that does not promote routine care but has long given Republicans cover to forgo Medicaid expansion. (Blackman, 4/22)

Through the acquisition, Molina will add approximately 50,000 Medicaid enrollees, including those from Cigna's STAR+PLUS program in the Hidalgo, Tarrant and Northeast service areas. It will also bump up the payer's revenue: In 2020, Cigna's Texas Medicaid contracts generated $1 billion in premium revenue. Molina currently operates six managed-care plans in the state and, at the end of the year, counted 357,000 members in Texas. Last year, it successfully protested its initial omission from the state's $10 billion Medicaid program and was able to keep its Medicaid contracts in Texas. (Tepper, 4/22)

The American Civil Liberties Union filed suit Thursday against the state of Iowa over a law that allows Medicaid to deny payments for gender transition surgery. Why it matters: The suit is the latest volley in nationwide fight over transgender rights, ranging from access to medical care to the ability to compete on sports teams. Details: The ACLU plans to argue that denying the surgery to transgender people violates equal protection rights, the Associated Press reports. (Reed, 4/22)

The ACLU of Iowa filed a lawsuit Thursday on behalf of transgender Iowan Aiden Vasquez, seeking to have an Iowa law exempting transition-related surgery from coverage under public health insurance systems like Medicaid deemed unconstitutional. The lawsuit, filed jointly with the national ACLU's LGBTQ & HIV Project, follows a similar suit filed in 2019 on behalf of Vasquez and another transgender Iowan, Mika Covington, that also asked the courts to end the state's practice of denying Medicaid coverage for transition-related care. (Fleig, 4/22)