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Politics, Elections and Government

Missouri Governor Axes Medicaid Expansion, Setting Up Lawsuit Over Future Of Health Care Program

Missouri Governor Mike Parson addresses senators and an audience gathered in the view gallery during his State of the State address on Wednesday, January 27, 2021, in the Senate Chambers of the Missouri State Capitol in Jefferson City.
Missouri Governor Mike Parson addresses senators and an audience gathered in the view gallery during his State of the State address on Wednesday, January 27, 2021, in the Senate Chambers of the Missouri State Capitol in Jefferson City.

The GOP-led Missouri legislature declined to fund Medicaid expansion, which was approved by voters in a constitutional amendment last year.

Gov. Mike Parson has pulled out of efforts to expand Medicaid, a move that almost certainly guarantees a lawsuit that could determine the future of a voter-passed initiative bolstering the health care program.

After voters approved a constitutional amendment last year expanding Medicaid, Parson’s administration had sent an amendment to the federal agency that oversees the program to follow through. The amendment would allow someone with an annual income of $17,600 or roughly $36,000 for a family of four to get coverage.

But the GOP-led legislature declined to fund expansion, citing concerns over the long term financial impact of the move. In a statement Thursday, Parson said he was withdrawing the amendment to the Centers for Medicare and Medicaid Services that would expand Medicaid.

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” Parson said. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”

What Parson was referring to in his statement is a scenario where his administration starts providing coverage to people in the expansion population — and then the program runs out of money because lawmakers didn’t appropriate funding.

But Parson’s decision almost certainly guarantees litigation.

That’s because the constitutional amendment includes language requiring coverage for people in the expansion population. What will likely happen is someone will try to apply for Medicaid, get rejected, and then sue in order to get coverage.

If the courts rule that Parson’s administration must let people in the expansion population into the program, lawmakers will be under huge pressure to fund expansion. If they don’t, then hospitals and doctors won’t be reimbursed when they provide services to people on Medicaid because the program will have run out of funding.

But if the courts decide that the state doesn’t have to provide health care coverage without funding approval from the legislature, then it effectively renders the Medicaid expansion amendment inoperable.

A decision to not go forward with Medicaid expansion would also mean the state would not get more than a billion dollars from the latest federal coronavirus relief plan. A provision in that legislation provides money to states that have not expanded Medicaid yet. Many critics of Republicans refusing to fund expansion have pointed out that this money could be used to pay for the state’s portion of the effort, contradicting the idea that Medicaid expansion would be a financial drag on the state.

“By backtracking on implementation of Medicaid expansion, Governor Parson is breaking his promise to the people of this state and violating his oath to uphold the Missouri Constitution,” House Minority Leader Crystal Quade, D-Springfield, said in a statement. “Whatever reputation he once had for respecting the law is gone forever, and he is just another politician whose word can’t be trusted. Medicaid expansion will still happen as the constitution requires, but because of the governor’s dishonorable action, it will take a court order to do it.”

This impending court case, which will likely be rendered from the Missouri Supreme Court, could have implications beyond the future of Medicaid expansion.

If the courts rule that expansion must happen, then it could be a pretext for Republicans to try to dismantle the Missouri Nonpartisan Court Plan that is used to select judges to Supreme Court and the state’s appellate courts.

Follow Jason on Twitter: @jrosenbaum

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