Missouri High Court Says Medicaid Expansion ‘Valid’

Jul. 23—JEFFERSON CITY — The Missouri Supreme Court on Thursday unanimously reversed a lower court decision that found the state's Medicaid expansion unconstitutional.

Moving with uncharacteristic speed, the high court overruled Cole County Circuit Judge Jon Beetem's decision that upended the long-running push to add as many as 275,000 low-income Missourians to the government-run health insurance program.

In doing so, the court called Medicaid expansion "valid," paving the way for the Missouri Department of Social Services to resubmit an application to the federal government outlining its plan to serve the additional enrollees.

"The Supreme Court has now spoken and decided that our clients are eligible for coverage," said attorney Chuck Hatfield, who represented three women who brought the lawsuit.

The federal government will pay 90% of the additional costs of expansion.

"There should be a huge infusion of money immediately," Hatfield said.

Groups favoring expansion, which was one part of former President Barack Obama's signature achievement, hailed the ruling.

"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. 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," said Amy Blouin of the Missouri Budget Project.

"This decision restores faith in our democracy and that the power of the people will continue to prevail over political grandstanding. For more than a decade, we have called upon lawmakers in Jefferson City to do the right thing and expand Medicaid," said Caitlyn Adams, executive director of Missouri Jobs for Justice.

Rep. Cody Smith, a Carthage Republican who chairs the House Budget Committee, was reviewing the case and had no immediate comment. Smith and fellow Republicans have taken a hard line for more than a decade against expansion, saying the state cannot afford it.

Smith's Senate counterpart, Dan Hegeman of Cosby, called the ruling "disappointing."

"The legal gymnastics employed by the court to get their desired political outcome sets a dangerous precedent and greatly diminishes the power of Missourians' elected representatives," said Hegeman, who has previously called for a revamp of how judges are appointed to the high court.

But Sen. Brian Williams, a Democrat from University City, said working families deserve access to health care.

"This is a big win for working families & a huge loss for Republican politicians who tried — and failed — to stop it," Williams said via Twitter.

The matter now heads back to Beetem. Based on the Supreme Court's ruling, it is expected he will direct DSS to begin making preparations for expanding coverage to more adults, regardless of whether the estimated $1.9 billion cost was included in the state budget by the Legislature and Gov. Mike Parson.

Parson, however, questioned whether his administration could immediately begin enrolling people without action on the budget from the Legislature.

"After today's court decision, the Executive Branch still lacks the necessary budget authority to implement MO HealthNet coverage to the expanded population. We are looking at what options may be available to us to seek additional budget authority and also pursuing legal clarity," Parson spokeswoman Kelli Jones said.

Voters approved expansion

The legal action that led to Thursday's court ruling came after the Republican-led House and Senate voted in May against funding the voter-approved expansion, prompting Parson to withdraw an application with the federal government outlining the more inclusive program.

The seven judges were asked whether the 2020 ballot initiative approved by 53% of the voters was fatally flawed because it did not include a specific source of revenue to fund it.

Hatfield argued the budget approved by lawmakers in May does not explicitly say expansion is prohibited. Therefore, he said, those who are eligible should receive coverage.

Attorneys for the state said the budget bills clearly don't anticipate the expanded population of enrollees. Rather, the spending blueprint is based on the MO HealthNet program serving its current roster of clients, which includes children, pregnant women and some disabled adults.

The court, in its 14-page ruling, however, wrote there is "no such limitation" in the budget bills.

And it said eligibility criteria for the program "are valid and now in effect."

The court was meeting on an expedited schedule because the expansion was supposed to go into effect on July 1.

Healthcare for Missouri, a coalition that lobbied for expansion, issued a statement expressing relief for the decision.

"We're grateful that the Missouri Supreme Court's unanimous ruling will bring clarity and resolution to this critical issue in which the voters spoke almost a year ago. We look forward to seeing Medicaid expansion swiftly implemented by the State so that all eligible Missourians receive the access to healthcare they need," the group said in a statement.

Nina Canaleo, a 38-year-old Kansas City mother with multiple sclerosis, lauded the ruling, saying, "Because of Medicaid, I'll be connected with treatment and therapy I need to more fully participate in the workforce and more fully enjoy life with my son. The positive impact of this decision cannot be overstated, and I am simply overjoyed."

Originally posted at 1:35 p.m. Thursday, July 22, 2021.

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