Boone County Commission News Release

Boone County Commissioner Visits Washington to Share Local Perspective on Budget Reconciliation

Elected officials from five states sound alarm about administrative and funding changes to SNAP and Medicaid

WASHINGTON (July 3, 2025) - Boone County Missouri's Northern District Commissioner Janet Thompson joined the National Association of Counties (NACo) and delegations from five state associations of counties for a visit to Capitol Hill to advocate for county priorities in two key aspects of budget reconciliation legislation. Local elected officials from Minnesota, Missouri, New York, North Carolina and Wisconsin met with leaders in both the House and the Senate June 24 to express concerns about the impacts on counties of proposed Medicaid reforms and administrative and funding changes to the Supplemental Nutrition Assistance Program (SNAP).

"I went to Washington as part of the Missouri Association of Counties (MAC) delegation to ensure that our Senators and Representatives, who would be voting on this legislation, understand the catastrophic impact it will have upon countless individuals and families in every county in our state. The impact of the proposed Medicaid reforms will be seen everywhere but will hit rural Missouri hardest of all. Rural hospitals are already at risk, with many hospitals having closed in the last few years, and these reforms will lead to the demise of many more. They will be unable to keep the doors open when patients arrive without health care coverage. Nursing homes, which now serve many Medicaid patients, also will close as funding streams disappear. Our neighbors with developmental and intellectual disabilities, who currently receive services and housing through Medicaid payments and may be clients of SB 40 Boards and our County Public Administrators, will also be directly adversely impacted by these actions."

Proposed administrative and funding changes to the SNAP program would reduce federal assistance for both administrative and benefit costs while also expanding work requirements, a change that furthers the administrative burden on states and counties. In House bill H.R. 1, the tolerance threshold for payment errors would also be reduced to zero, creating an even greater administrative burden. While SNAP cost shifts impact all counties, the impact is especially significant for counties in the 10 states where counties administer SNAP benefits (including fly-in participants from Minnesota, New York, North Carolina and Wisconsin). In these states, county administrative costs are projected to jump by more than 30% per year even as the federal benefits share declines.

Proposed Medicaid reforms could similarly increase the financial and administrative burden on counties, threatening a longstanding federal-state-local partnership to provide healthcare for residents. Among other impacts, proposed reforms would increase the number of uninsured residents by 10.9 million by 2034, significantly raising uncompensated care costs for counties, many of which operate as providers of last resort through public hospitals and emergency services. Much like SNAP, navigating proposed work requirements for Medicaid recipients further increases the administrative cost for counties.

"As essential intergovernmental partners, the voices of county leaders must be heard as members of Congress navigate the budget reconciliation process," said NACo Executive Director Matthew Chase. "When it comes to Medicaid and SNAP, all counties have a significant stake in the outcome of this process, and we need to communicate our concerns here in Washington."

The fly-in came as the Senate reviewed proposed text for its version of the reconciliation bill, ultimately passed on July 1 with several notable changes in comparison to the House bill passed earlier in June.

"These proposed reforms to SNAP and Medicaid will prove devastating to the health and well-being of our communities and will gut our health care system, especially in rural Missouri. Even in Boone County, with a community built on education and health care, hospitals and other health care providers will be unable to address the health care needs of Boone County residents when uninsured individuals and families from other areas flood their emergency rooms, their outpatient clinics, their nursing home beds."

For more information from the National Association of Counties about county priorities in budget reconciliation, click here. For more information about counties and Medicaid, click here. For more information about counties and SNAP, click here.

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The National Association of Counties (NACo) strengthens America's counties, including nearly 40,000 county elected officials and 3.6 million county employees. Founded in 1935, NACo unites county officials to advocate for county government priorities in federal policymaking; promote exemplary county policies and practices; nurture leadership skills and expand knowledge networks; optimize county and taxpayer resources and cost savings; and enrich the public's understanding of county government. www.naco.org