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With the Freedom Caucus threatening to filibuster approval of the tax on health care providers if an ever-growing and changing list of their demands is not met, the shadow budget would attempt to show what would have to be cut if the funding stream is not approved.

“We’re going to have to make adjustments to the budget if we don’t have $4.5 billion,� said Senate Appropriations Committee Chairman Lincoln Hough, R-Springfield, Thursday.

At issue is the Federal Reimbursement Allowance tax, which is paid by hospitals, nursing homes and other health care providers. The tax, which expires Sept. 30, generates more than $4 billion to help pay for the state’s Medicaid program.

The budget, which must be completed by May 10, can’t be finished until the tax is in place, Hough said.

The Freedom Caucus says it will hold up passage of the FRA until a bill banning Planned Parenthood from the Medicaid program is signed by Gov. Mike Parson.

The group also plans to keep their blockade in place until the Senate passes a measure that would change how voter-initiated constitutional amendments are approved. The House sent its version to the Senate Thursday, leaving it up to the Senate to push it across the finish line.

One member of the splinter group, Sen. Denny Hoskins, R-Warrensburg, warned that he also plans to slow the passage of the budget when those bills are being debated.

“I look forward to offering several conservative amendments when the budget bills come to the Senate floor,� Hoskins said on social media.

The Senate Appropriations Committee Wednesday finalized its work on the package of spending bills for the fiscal year beginning July 1, putting it on track to hit the full Senate next week.

It includes additional spending, pushing it closer to the $53 billion level sought by Parson than the $51 billion plan approved earlier in the House.

Among the changes made by the Senate is a plan to boost the minimum rate of pay for contracted workers who care for the state’s developmentally disabled population to $17 per hour.

That could help recruit and retain more workers in an industry facing challenging workforce issues.

The Senate proposal also includes additional money for child care programs in a bid to get more people into jobs.

The Senate version also rejected a House plan to pay $10 million for studies into the use of psilocybin mushrooms to treat mental health conditions.

And the Senate plan also includes $7.5 million to pay for testing water in schools for fentanyl.

House Budget Committee Chairman Cody Smith, R-Carthage, said he is “reserving judgment� on the Senate changes as he reviews the document.

The current schedule has the full Senate signing off on Hough’s budget plan next week, followed by time spent trying to hammer out a final spending blueprint with the House version.

The House plan reduces Parson’s proposal by about $2 billion. Among items cut by the House is a nearly $53 million plan to redevelop the mostly abandoned Missouri State Penitentiary in Jefferson City as a tourist site.

The House version also reduces by more than $574 million the amount Parson had sought for the state’s Medicaid program, which provides health insurance to low-income Missourians.

The House also reduced Parson’s call for a 3% boost to colleges and universities to a 2% increase. The Senate Appropriations Committee restored that amount to 3%.

The House also would add $25 million to build a facility to teach engineering at the University of Missouri-St. Louis.

After committing major state funds to rebuild and widen Interstate 70 last year, the House plan allocates $727 million to improve Interstate 44. In addition, $100 million will go to repair rural roads across the state.

The state also could see a new state park in southwestern McDonald County, which is represented by House Budget Committee Vice Chairman Dirk Deaton.

Missouri taxpayers also will be on the hook for $8 million for Parson’s decision to send National Guard troops to Texas as part of a Republican-led effort to highlight immigration as an election-year issue.

The plan leaves Parson’s budget proposal on teacher pay intact. Base salary for teachers would rise to $40,000, up from the current national low of $25,000. The cost is about $4 million.

Facing a tight deadline, Smith said Thursday he has developed a “creeping doubt� about being able to finish the budget by the deadline.

But, he told reporters Thursday, “As of right now we do have time.�

Hough did not offer any examples of what programs or projects might be left by the wayside if the health provider tax isn’t approved.

“We will have to make decisions associated with budget bills if we don’t have $4.5 billion. You will see cuts if we don’t do the FRA,� Hough said.

Originally posted at 10 a.m. Friday, April 26. Updated 2 p.m. Sunday, April 28 to correct Rep. Dirk Deaton's position on the House Budget Committee to vice chair.