The Columbia Missourian tells us that the House Interim Committee on Medicaid Transformation decided to begin drafting a Missouri Medicaid expansion proposal this week. The article is unclear on what exactly a waiver would look like that could "give the state access to federal funds on its own terms." But I can't fault The Columbia Missourian for being unclear on the limits of state discretion under a waiver, because it isn't clear to anyone yet. All of the study models for the Missouri Committee (Iowa, Indiana, and Arkansas) are still in a state of flux.
And isn't that the real question: how far will HHS bend to entice buy-in now that it may not be coerced? How far will the Medicaid statute itself as well as the ACA allow HHS to bend?
In the meantime, Paul Rand's election year proposal to block grant Medicaid is also apparently under study in Missouri. Other states have used the 1115 waiver process to substantially block grant Medicaid (think Rhode Island) but that is a negotiated process -- just as, I suspect, the ACA Medicaid expansion waiver process will be.