Despite lack of funding, Parson administration laying groundwork for Medicaid expansion in Missouri

May 11—JEFFERSON CITY — Despite Missouri's GOP-controlled Legislature providing no money to add more people to the state's Medicaid program, Gov. Mike Parson's administration appears to be laying the groundwork for the voter-approved expansion.

In a proposed rule change filed with the Missouri Secretary of State's office, the Department of Social Services is seeking to expand the program to adults between ages 19 and 64.

The addition of that age group would address changes endorsed by 53% of the state's voters in August 2020 that would allow as many as 275,000 low-income Missourians to receive health care benefits through Mo HealthNet.

It would give medical providers the ability to begin enrolling people earning under $18,000 per year beginning on July 1.

"This proposed amendment allows qualified hospitals to make Medicaid presumptive eligibility determinations for the Adult Expansion Group (AEG), per Article IV Section 36© of the Missouri Constitution," the rule change says.

Changes in state rules typically undergo a review process and are put in place with little fanfare. In this case, given the high cost and the political ramifications, the rule could face a challenge that would put the question to a special panel of lawmakers.

The Missouri Hospital Association, which heavily backed the expansion effort, said the rule change would expedite enrollment of more people. But the maneuver may not stop the issue from being decided in a courtroom.

"The Parson administration continues to address the regulatory issues related to the expansion population. However, I don't think efforts to lay the groundwork for the expansion necessarily signal that the issue won't end up in litigation," said MHA spokesman Dave Dillon.

On Friday, the GOP-controlled House and Senate sent Parson a budget plan that adds no additional money to pay for the expansion, raising questions about whether it will be challenged in court.

Lawmakers opposed to the Affordable Care Act, known as Obamacare, said the state cannot afford the long-term costs of the expansion, even though the state's budget is currently brimming with emergency stimulus cash from the federal government.

That same money could help pay for the expanded adult population when it becomes eligible on July 1.

The rule change caught Senate Appropriations Committee Chairman Dan Hegeman, R-Cosby, by surprise Monday.

"I was unaware that was moving forward," said Hegeman, who opposed funding the expansion.

Rep. Sarah Unsicker, D-Shrewsbury, who supports expansion, said she was happy with the development.

"I think it's necessary. I know DSS has been moving forward with preparing for Medicaid implementation. They are getting ready to train their employees. It has to be implemented July 1," Unsicker said.

In comments to reporters last week, Senate Majority Leader Caleb Rowden, R-Columbia, said there may not be enough money in state coffers to pay for an entire fiscal year of expansion, but it won't stop the expansion from moving forward.

"My perspective has always been that, at the end of the day, if the governor doesn't freeze enrollment of the new population when they are eligible, then there is money in the budget for those folks to enroll," Rowden said.

As part of the proposed rule change, the department said the expansion is estimated to cost $1.85 billion, with the federal government paying $1.57 billion of that bill.

The governor's office and the Department of Social Services did not immediately respond to requests for comment Monday.

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