Missouri became the latest state to approve Medicaid expansion through a ballot measure, winning the approval of 53.2% of voters.
According to election results compiled by Vox, 46.8% of about 1.3 million voters rejected expansion.
The vote comes on the heels of Medicaid expansion earning a narrow win in Oklahoma a month ago. In red states that chose not to expand the program under the Affordable Care Act, ballot measures have become an alternative avenue to Medicaid expansion.
Utah, Idaho and Nebraska approved expansion through similar means.
Amendment 2's approval would expand Medicaid eligibility to more than 200,000 additional people in Missouri, The Kansas City Star reported.
The ballot measure faced opposition from Republicans, most notably Missouri's Secretary of State Jay Ashcroft, who invoked a rarely-used strategy to speed up the process of verifying signatures, according to the Star. This allowed GOP Gov. Mike Parson to move the vote up to the primary instead of conducted it as part of the general election in November.
Missouri's ballot measure did enjoy support from the state's Chamber of Commerce Industry, which described it as a "pro-jobs measure," St. Louis Public Radio reported.
Once Missouri's expansion is finalized, it will be the 38th state to expand the program.