The Missouri Catholic Conference believes there are Medicaid reforms that can be adopted so that recipients take ownership for their health care, such as making reasonable co-pays. Another reform would provide incentives to avoid unnecessary emergency room visits. In general, reforms should especially target assistance to the working poor who often cannot afford private health insurance and may not qualify for the subsidies offered under the federal Affordable Care Act. For more on the MCC perspective see Missouri Can Create Its Own Medicaid Program.
Not all opposition to Medicaid expansion focuses on state budget concerns. Even if an expansion can save on the spending of state general revenue some critics believe Medicaid undermines the work ethic and creates a welfare state where people feel entitled to benefits.