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Missouri Medicaid expansion gets its day in court as July 1 start date looms

·4 min read

The future of Medicaid expansion in Missouri is in a Cole County judge’s hands.

Judge Jon E. Beetem heard arguments Monday afternoon in a lawsuit brought by three Missouri women who will qualify for Medicaid on July 1 under the constitutional amendment voters passed last August to expand eligibility for the program.

The expansion was scuttled in May by Gov. Mike Parson after the Republican-dominated state legislature refused to pay for it.

Beetem will decide whether or not the state must still allow an estimated 275,000 low-income Missourians to enroll in the health program. He told attorneys Monday that he plans to rule within the next two days, before the eligibility begins in July, but an appeal from either side is also expected.

Chuck Hatfield, attorney for expansion advocates, argued that it does not matter whether or not lawmakers passed additional funding for expansion, because the state must use the existing funds budgeted to allow everyone who is eligible to be covered.

“If they’re going to fund Medicaid this population would have to be included,” he said.

Missouri officials, represented by solicitor general Dean John Sauer said the state does not have the authority to do that because lawmakers specifically rejected funding for the “expansion population.”

“It’s perfectly clear that what’s going on here is appropriation for just the pre-expansion population and not the expansion population,” Sauer said.

The stakes for the decision are high. The state’s Medicaid program already faces financial disaster if lawmakers do not renew a routine tax on medical providers that generates billions of dollars to pay for the health program, before it expires Sept. 30. The renewal has been tied up in a fight led by the state Senate’s hardest-right Republicans to block Medicaid coverage of certain birth control methods and deny payments to Planned Parenthood.

Parson has not yet called a special legislative session for lawmakers to pass a renewal, which would likely include the birth control coverage ban. He had said he will cut from the budget if it is not passed by July 1.

If Beetem orders the state to start enrolling new Medicaid recipients in July, the program would be underfunded, forcing Parson to call another session asking the legislature for additional money they have already refused.

The three plaintiffs in the case all have chronic health conditions but cannot afford their own insurance, according to the lawsuit. Two of them, Autumn Stultz of Springfield and Stephanie Doyle of St. Louis, are single mothers and low-wage earners who make too much to qualify for Medicaid. The current program allows adults with children to enroll only if they earn less than 22% of the federal poverty level — about $5,800 a year for a family of four.

The third plaintiff, Melinda Hille, is a Fenton woman who has been unable to work because of Type 1 diabetes and other conditions that have landed her in and out of the hospital since 2015. She’s been unable to get health insurance because Medicaid in Missouri currently does not cover adults of any income who are not disabled or do not have children, and said at an April rally for expansion that she reuses her insulin needles to make them last.

The expansion would allow those earning up to 138% of the poverty level to enroll — about $17,700 for a single adult.

Beetem last week blocked two additional plaintiffs from joining the suit, ruling it would delay the outcome.

The state’s health care providers spent months preparing for expansion. The Missouri Hospital Association supported it as an economic boon to the industry — particularly in rural Missouri where 10 hospitals have closed since 2014 and numbers of uninsured people are high. After years of refusals from the legislature to expand eligibility for the program, progressive groups put the issue on a statewide ballot. It passed with 53% support last August.

But Republican lawmakers balked at the cost, which Parson’s administration estimated at $130 million in state funds for the first fiscal year. That would come with $2 billion from the federal government. Missouri is sitting on a budget surplus and will receive several billion dollars of federal COVID-19 aid this year and next year.

Lawmakers overwhelmingly rejected the expansion funding in the budget they sent Parson in April, arguing that because only lawmakers can appropriate money, the decision to expand still lay with them.

They have called Medicaid expansion an extension of welfare to able-bodied adults who could acquire their own insurance, and sent Parson a budget that redistributed the expansion funds toward increased nursing home payments, new mental health programs and care for the developmentally disabled.

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