Medicaid expansion may yet happen in Missouri, according to state Sen. Ryan Silvey.

The Kansas City Republican said on Friday that he believes he has the support he needs to pass a Medicaid expansion bill that addresses the concerns of his more conservative colleagues.

“More and more people are coming to the realization that, while we don’t necessarily like Obamacare — while we aren’t the biggest fans of putting more people on Medicaid — that the way the current system is and the way the courts have continued to uphold it, it’s going to be damaging to our hospitals if we don’t do something,” Silvey said at an Overland Park, Kan., event sponsored by the Mother & Child Health Coalition and other groups.

Under the Affordable Care Act, disproportionate share hospital (DSH) funds, which the federal government pays hospitals to offset the costs of charity care, will be reduced starting Oct. 1, 2015.

The ACA was designed to eliminate the need for DSH funding by providing insurance to those who receive charity care. But neither Missouri nor Kansas has expanded Medicaid, leaving hospitals with the worst of both worlds.

As envisioned under the health care reform law, Silvey’s plan would expand Medicaid to those with incomes up to 138 percent of the federal poverty level — about $16,104 in annual income for an individual and $32,913 for a family of four — and add about 300,000 more people to Missouri’s Medicaid rolls. But it would also create additional requirements.

Money saved by expansion would go into a trust fund to fill funding gaps when federal support for Medicaid is reduced. If the trust fund runs out, Medicaid payments to providers would be reduced.

Under the ACA, the federal government has agreed to pay all Medicaid expansion costs for three years. After that the federal share will gradually decline until it reaches 90 percent, where it will remain.

Silvey said his plan is supported by hospitals and other provider groups.

He said the compromise bill was close to being approved at the end of the 2014 legislative session but was blocked by a handful of influential legislators.

Now that some of those expansion opponents, particularly Republican Sen. John Lamping of St. Louis County, are not seeking reelection, Silvey said he’s more optimistic about the bill’s chances.