Cole County judge sides with state in Medicaid lawsuit

JEFFERSON CITY, Mo. (KMIZ)

The state of Missouri was right not to expand Medicaid eligibility despite a voter-approved constitutional amendment that would open up the program to more people.

Judge Jon Beetem issued his ruling on a lawsuit challenging the state's refusal to expand Medicaid on Wednesday after hearing arguments in the case Monday. Beetem sided with the state, which argued that the constitution prohibits voter-approved measures that create new programs without specifying how to fund them.

The voter-approved measure, called Amendment 2, will create a class of 275,000 people newly eligible for MO HealthNet -- the state's Medicaid program -- Beetem said in his ruling. Ruling for the plaintiffs, who sought to force the state to follow through with expansion, would in effect be a "court-ordered appropriation," Beetem said.

The Missouri General Assembly failed to appropriate money for expanded Medicaid coverage and later the governor ordered state officials to take plans for expansion off the table, citing the constitution's prohibition against ballot measure that create new programs without appropriating money for them. Supporters of expansion argued that the measure didn't create an entirely new program, just expanded eligiblity, and that the state could appropriate money with a supplemental budget.

MO HealthNet 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.

Expansion was set to begin July 1, when the state's new fiscal year begins.

The plaintiff's issued the following statement on the court's decision.

As all observers predicted, the issues around Medicaid Expansion will be decided in the Court of Appeals. We are disappointed in today's ruling, but believe the Court of Appeals will disagree.

The trial Court's analysis here found that "Plaintiffs are absolutely right" on the issues that were presented to the court. The court then found that the initiative was not validly enacted because it used the initiative to appropriate. This is not an issue the State raised or argued at trial.

We believe the Court of Appeals has already decided, in the Cady case, that Amendment 2 was a valid use of the initiative process and that it did not unlawfully appropriate funds.

We will immediately appeal this decision to the Court of Appeals for the Western District of Missouri.

Chuck Hatfield and Lowell Pearson