SJR 4 - This constitutional amendment, if approved by the voters, modifies provisions of current law expanding MO HealthNet eligibility to able-bodied adults up to 138% of the federal poverty level. This amendment repeals language prohibiting the use of restrictions or burdens on eligibility or enrollment standards for this population that exceed those of non-expansion MO HealthNet populations. Under this amendment, eligibility for MO HealthNet services under the expansion provision shall be determined each fiscal year based on specific appropriations made by the General Assembly. Additionally, this amendment adds language specifying that nothing in the MO HealthNet expansion provision or any other provision of law shall be construed to mandate the appropriation of funds by the General Assembly for MO HealthNet services for the expansion population. The General Assembly shall have the right to appropriate funds in a specified amount, or to not appropriate funds, at its discretion, for the MO HealthNet expansion population separate from other MO HealthNet populations. In any given fiscal year, a MO HealthNet population, service, or type of provider shall only receive MO HealthNet benefits if an appropriation for that population, service, or type of provider is made in that fiscal year. The state shall not provide any payments, add-ons, or reimbursements to health care providers through MO HealthNet or medical assistance services to persons who are not considered Missouri residents under federal Medicaid regulations. Finally, this amendment requires, subject to approval of a waiver, able-bodied adult MO HealthNet participants, ages 19 to 64, to participate in work and community engagement requirements. Participants shall complete at least 80 hours a month of any combination of specified work, education, job search, child care, and volunteer services. The Department of Social Services shall provide reasonable accommodations for individuals with disabilities who are not otherwise exempt from the work and community engagement requirements under this amendment to ensure that the participants are able to comply with the requirements, including exemptions, modifications of hours, and the provision of necessary support services. MO HealthNet participants who shall not be required to comply with the work and community engagement requirements include: (1) those under 19 and over 64; (2) those who are medically frail, as defined in the amendment, including those with certain disabilities; (3) those who are pregnant or caring for a child under one year of age; (4) those who are primary caregivers of a dependent child under the age of six or a dependent adult; and (5) those who are also participants of Temporary Assistance for Needy Families or the Supplemental Nutrition Assistance Program and are exempt from work requirements under those programs. The Department may permit further exemptions in areas of high unemployment, limited economies or educational opportunities, or lack of public transportation, or for good cause, as defined in this amendment. This amendment is substantially similar to HCS/HJR 117 (2022) and similar to SJR 60 (2020) and SJR 32 (2020). SARAH HASKINS