Missouri Supreme Court sides with Medicaid expansion supporters

JEFFERSON CITY, Mo. (KMIZ)

The Missouri Supreme Court ruled Thursday that the state's voter-approved Medicaid expansion does not violate the state constitution's prohibition on voters creating new programs that aren't funded.

The court in its unanimous 14-page decision sent the case back to Cole County circuit court and instructed the judge to enter a judgment in favor of those who sought expansion of the program. Three women who were eligible under the expansion sued the state in May after the legislature failed to appropriate extra money for the program and Gov. Mike Parson instructed his administration not to expand eligibility.

The expanded eligibility was set to begin July 1 with the state's new fiscal year. Voters approved the amendment to expand the health insurance program for low-income people last August. The expansion would raise income requirements and make an estimated 275,000 more Missourians eligible for Medicaid.

"Today was an enormous step forward for 275,000 Missourians who need health care that they don't currently have access to, so I could not be happier," said Lowell Pearson, an attorney for the plaintiffs.

Cole County Circuit Judge Jon Beetem ruled last month in favor of the state, which argued that the constitution's prohibition on voter-approved amendments creating new programs without funding meant expansion could not go forward. Supporters of expansion argued the vote didn't create any new program, it simply expanded one that already existed, which the legislature was bound to fund.

The supreme court's opinion also stated that the legislature's appropriations bills did not exclude funding for covering an expanded Medicaid population.

"With no ambiguity, the amounts appropriated ... cannot be used to alter the plain language of the purposes stated – to fund MO HealthNet without distinguishing between benefits provided to individuals who are eligible as part of the preexpansion population" and the newly eligible, the court wrote in its opinion.

A spokesman for the Missouri Attorney General's Office, which argued in court against expansion, said the office will not comment because the case is ongoing.

MO HealthNet, the name of the state's Medicaid program, has one of the nation's strictest eligibility rules. It does not cover most non-disabled adults without children. Parents are able to qualify if their household income is below 21% of the federal poverty line, which in 2021 is less than $5,000 a year for a family of three.

Under expansion, an individual making about $18,000 per year would be eligible.

“Today was another big win for all Missourians," Caitlyn Adams, executive director of Missouri Jobs with Justice, said in a statement. "This decision restores faith in our democracy and that the power of the people will continue to prevail over political grandstanding. For more than a decade, we have called upon lawmakers in Jefferson City to do the right thing and expand Medicaid."

The American Cancer Society Action Network also praised the decision. “Increased eligibility for Medicaid increases access to vital health care services, significantly reduces health and cancer disparities, and improves survivorship for cancer," government relations director Emily Kalmer said in a statement.

Conservative political group Americans For Prosperity-Missouri said the ruling risks the state's "long-term fiscal health."

"Missouri taxpayers now face potential cuts to education or a tax increase to cover these new costs," state director Jeremy Cady said in a statement.

David Tyson Smith, a democrat who represents part of Columbia and Boone County in the Missouri House of Representatives says affirmation is the right decision.

"You know, this is exciting, it's long overdue," Smith said. "I'm excited for the citizens of Missouri, I'm excited for the citizens in my district, this is definitely justice done."

At the same time, Chuck Basye, a republican representing parts of mid-Missouri in the state house says the expansion will likely lead to reforms.

"The Supreme Court ruling is disappointing, however, I am confident the Missouri General Assembly will take the appropriate action to comply in a responsible manner," Basye said. "The Medicaid program consumes a large portion of the state budget, therefore the legislature will most likely concentrate on reforms to control costs to keep education funding intact."