About
Disability, child welfare, and health policy from a former Missouri State Legislator on the work most people never see.
Most policy writing is done by people who haven’t been in the room. This one isn’t.
Sarah Unsicker served four terms in the Missouri House of Representatives (2017–2025), where she served as caucus Policy Chair, Ranking Member of the Children and Families Committee, and on Budget and Health Appropriations committees. She holds a J.D. from Washington University in St. Louis.
Sarah’s writing focuses on disability and education policy, child welfare and foster care, health policy, and legislative craft from the concept to the courtroom. She writes from inside the work, not outside it.
Why this exists
There’s a particular kind of policy work that doesn’t get written about. Not the bills that make headlines, but the appropriations footnote that quietly funds (or defunds) a program serving thousands of people. Not the floor speeches, but the committee hearing where a fiscal note gets challenged and a bill’s whole trajectory changes. Not the Supreme Court ruling, but the Attorney General opinion from 1972 that quietly shaped fifty years of state practice. Not the policy as it’s announced, but the policy as it actually gets implemented — by caseworkers, by judges, by clerks, by IT systems, by people who never get asked what they think.
That’s the work this blog is about. It’s the work most people in policy never see, and it’s where most of the actual decisions get made.
What this blog covers
Disability policy. Special education, ABLE accounts and asset limits, Medicaid Home and Community-Based Services, employment policy, and the legislative craft of drafting disability legislation. Sarah helped draft and pass Missouri legislation excluding ABLE account savings from the blind pension asset limit, and has worked alongside some of the people who built the modern federal disability rights framework.
Education policy. Special education and IDEA implementation, school discipline and reporting requirements, charter expansion, the school-funding formula, and the gap between what education statutes say and how they actually function in classrooms. Sarah did most of the drafting on Missouri’s 2017 revisions to school reporting requirements, sponsored under another legislator’s name — the kind of cross-aisle ghost-drafting work that’s invisible to outside observers but central to how legislation actually gets written.
Child welfare and foster care. The missing-children problem, the “legal orphans” problem (children whose parental rights have been terminated but who have no adoptive home), Children’s Division accountability, foster care prevention funding, the Family First Prevention Services Act, and the federal frameworks that constrain state choices.
Maternal and infant health. Sarah wrote and passed the Missouri legislation that created the state’s Pregnancy-Associated Mortality Review Board, codified at §192.990 RSMo. The Board has since produced the data that drives the state’s understanding of why women die in pregnancy and the year after — overwhelmingly from preventable causes, overwhelmingly from mental health and substance use conditions. Postpartum Medicaid coverage, the politics of mortality data, and what the Board has actually found.
Medicaid and the safety net. State Medicaid policy is where federal frameworks meet state choices meet individual lives, and almost no other domain of state government has comparable stakes for as many people. Sarah’s Medicaid work has focused particularly on eligibility determinations — the administrative machinery that decides who actually receives coverage and who falls through the cracks, where the gap between eligibility on paper and eligibility in practice is often the difference between care and no care. Eligibility administration, the asset-limit and benefits-cliff problems that keep people trapped in poverty, postpartum and children’s coverage, long-term services and supports, and the implementation politics of expansion. Sarah served on the subcommittee where these decisions are actually made and worked on Medicaid policy across her four terms.
Legislative process and analytical method. How bills actually pass, especially from the minority party. How to read an Attorney General opinion. How to find the policy decisions hidden in IT and infrastructure choices. What eight years of watching Missouri legislative sessions taught Sarah about how American state government really works. This subject area is the meta layer that runs through everything else — it’s about how to read the kind of policy this blog covers, not just what’s in it.
What’s coming
Case studies on specific legislation Sarah worked on — what the underlying problem was, how the bill came together, what passed, what didn’t, and what was learned. The Pregnancy-Associated Mortality Review Board. The ABLE account expansion. School reporting reform. Disability employment. Foster care accountability. Medicaid eligibility and managed care. These are the cases Sarah knows firsthand.
She’ll also write about live policy questions as they come up — federal frameworks that shape state decisions, AG opinions and court rulings worth understanding, and the kinds of things hiding in plain sight in state government that nobody else is writing about.
Get in touch
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If you want to talk about a specific question — for your organization, your reporting, your work — Sarah can be reached at contact@sarahunsicker.com.
