JEFFERSON CITY, Mo. (AP) — Missouri’s GOP-led Legislature on Wednesday renewed a more than $4 billion Medicaid program that had been blocked for months by a Republican faction that used it as a bargaining tool.

The bill which now heads to Gov. Mike Parson will renew a longstanding tax on hospitals and other medical providers.

Money from the tax is used to draw down $2.9 billion in federal funding, which is then given back to providers to care for low-income residents on Medicaid health care.

Because the tax is crucial to the state’s budget, the Senate’s Freedom Caucus had been leveraging the bill to pressure Republican leaders to pass a bill kicking Planned Parenthood off the state’s Medicaid program, which the Legislature did last month.

Later, the Freedom Caucus also demanded that the Legislature pass a measure to raise the threshold for amending the state constitution. Currently, amendments need support from 51% of voters stateswide.

If approved by voters, the Republican proposal would make it so constitutional amendments also need support from 51% of voters in a majority of congressional districts.

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Senate Freedom Caucus members allowed a final Senate vote of approval on the Medicaid tax last week, even though the constitutional amendment change still has not passed the Legislature.

The House took the hospital tax renewal up Wednesday, voting 136-16 to send the measure to Parson.

Democratic House Minority Leader Crystal Quade on Wednesday told colleagues on the chamber floor that the tax is essential “to function as a government” and “provide the most basic services.”

“This shouldn’t be used as a hostage in a terrorist negotiation,” Quade said.

Republican Rep. Tony Lovasco argued that Missouri’s reliance on the tax, and on federal Medicaid funding, hurts the state.

“The fact that we are yet again leaning on the federal government and their manufactured, printed money in order to get by in Missouri is just not a positive,” Lovasco said on the House floor.

Parson is expected to sign the bill.

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