The cuts will result in more than 700 lost jobs. Medicaid programs will be slashed by $32 million. One Columbia pharmacist didn't agree with how much money was cut from health care.

"It just seems like an exorbitant amount of money to be cut from the budget, and I didn't foresee that," said Anne Bromstedt, a pharmacist at Columbia pharmacy Kilgore's.

Bromstedt said more Medicaid recipients have been to her pharmacy than usual during the economic recession. 

Missouri's big budget cuts are the result of a 10 percent decline this year in the state's revenue. Nixon has already cut $634 million from the more than $23 billion state budget lawmakers passed this spring. As many people blame the recession for the budget problems, the Missouri Association for Social Welfare believes the cuts stem from a larger problem.

"Budget problems exist in the first place because Missouri has a very inadequate tax structure," said Bob Quinn, the organization's executive director. "We don't collect enough in revenue to provide services to people even when times are good. "

The Medicaid billing formula will change, affecting more than 16,000 codes for various services. Health care providers will get smaller state reimbursements for providing certain services to Medicaid recipients. These services include X-rays, optical care, and midwife care.

State officials say Missourians on both Medicaid and Medicare will have most services transferred to the federally-run Medicare. Nixon said eligibility for programs will not change for those individuals. He has ruled out tax increases in order to balance the budget.