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Missouri Supreme Court Revives Medicaid Expansion In Unanimous Decision

The Missouri Supreme Court has ruled that a 2020 ballot initiative that expanded Medicaid in the state did not violate the law.
Nat Thomas
/
St. Louis Public Radio
The Missouri Supreme Court has ruled that a 2020 ballot initiative that expanded Medicaid in the state did not violate the law.

The unanimous decision means low income Missourians eligible via a 2020 ballot initiative can sign up for the health care program, even though the legislature didn’t fund it.

An additional 275,000 low-income individuals in Missouri are again eligible for publicly-funded health care.

In a unanimous opinion handed down Thursday, the state Supreme Court ruled that a 2020 ballot initiative to expand Medicaid did not require lawmakers to appropriate money, and therefore did not violate state law.

“The General Assembly chose to appropriate funds for the MO HealthNet programs for FY 2022,” the judges wrote in what’s known as a per curiam opinion, or one that is not written by a specific judge.

“This was one of presumably thousands of difficult decisions made each year during the appropriation process. But, having made this decision, DSS and MO HealthNet are bound by article IV, section 36(c) concerning which individuals are eligible to enroll when it spends the appropriated funds. Consequently, DSS has appropriation authority to provide services for all individuals eligible for MO HealthNet, including individuals eligible for coverage and services.”

MO HealthNet is the official name for Missouri’s Medicaid program.

In other words, the court said, newly eligible individuals will simply draw from the same pot of money as all other beneficiaries. Lawmakers would then have to decide what to do when the current appropriation runs out.

The decision does not mean newly eligible Missourians can access benefits immediately. Gov. Mike Parson in May withdrew federal paperwork that set up the enrollment process. His office did not immediately respond to a request for comment.

Lowell Pearson, one of the attorneys for three women seeking to get access to Medicaid, said the ruling was a total victory for his clients. He said it will be up to Cole County Judge Jon Beetem to decide when people can start to enroll, but he predicted his clients will be enrolled “sometime in August.”

“On August 4 last year, the voters said ‘we want these people to get Medicaid,” Pearson said. “We’re a major step closer to them getting it.”

The amendment, which passed with 53% of the vote in August, made adults between the ages of 19 and 65 eligible for Medicaid if they make 133% of the federal poverty level, or about $35,200 for a family of 4. It also prohibited the state from enacting work requirements for Medicaid recipients. Currently, very few adults who have no dependents are eligible for Medicaid.

Amy Blouin, the president of the Missouri Budget Project, which supports expansion, said in a statement she hoped expansion would be implemented quickly.

“As a result of the Supreme Court’s ruling, Missourians across the state will finally be able to realize the health and economic benefits of Medicaid expansion,” she said. “State after state has shown that in addition to providing insurance to those eligible, expansion is a fiscal and economic boon to state economies and budgets,” Blouin said. “Not only do states save money on existing health services, but federal funds from expansion create jobs and increase economic activity, generating additional tax revenue to fund the state’s share of expansion.”

Follow Jason on Twitter: @jrosenbaum

Follow Rachel on Twitter: @rlippmann

Copyright 2021 St. Louis Public Radio. To see more, visit St. Louis Public Radio.

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