Missouri cannot deny or restrict those newly eligible for Medicaid benefits, a trial court judge ruled Tuesday, requiring the state to expand its low-income health care program to include roughly 275,000 additional Missourians.
Cole County Circuit Judge Jon Beetem sided with three women suing the state and their attorneys, following the orders of a state Supreme Court decision last month. He held a hearing last week for the parties to determine the details of how enrollment would proceed after the high court ruled that a voter-approved amendment expanding MO HealthNet, the state's Medicaid program, was constitutional.
The state's Department of Social Services is banned from "prohibiting individuals eligible" for enrollment and "imposing any greater or additional burdens or restrictions on eligibility ... than on any other population eligible for benefits under the MO HealthNet program," Beetem wrote in his order.
Beetem's order effectively ends the legal battle surrounding Medicaid expansion in Missouri, which began after the state legislature didn't include funding for that expansion in the annual budget. Three women eligible for benefits under Amendment 2, which passed with 53 percent of the vote last year, sued the state. An initial ruling by Beetem that ruled the amendment unconstitutional was overturned unanimously by the Missouri Supreme Court, which left the details of enrollment and injunction to the trial judge.
Attorneys representing the state asked Beetem in last week's hearing for more time – up to two months – to prepare for expansion, which they said required increased staffing and updated computer infrastructure. Attorney Chuck Hatfield, representing the women suing the state, argued that between the recent court ruling and the time between the amendment's passing and the approved annual budget, the state had already had time to prepare for expansion.
The state must begin enrolling those newly eligible into Medicaid immediately under the new order, and officials from the Department of Social Services not be able to argue whether it needs more time to prepare for expansion. Under the Affordable Care Act, Missouri pays for ten percent of the state's Medicaid funding; the remaining 90 percent is matched by the federal government.
As the legislature did not provide enough funding in the annual budget for Medicaid expansion, the state will have to decide how to proceed with doing so.
Possibilities include diluting the Medicaid pool – resulting in each person eligible receiving less money under the program – or a legislative special session to add remaining funds to the budget.
Under Medicaid expansion, Missourians ages 19-65 earning less than $17,774 annually per individual or $37,570 for a four-person family – up to 138 percent of the federal poverty line – will qualify for benefits and services. Another attorney representing the three women said those people often fell into a "coverage gap," and previously called the Missouri Supreme Court decision a "major step forward" for health care in Missouri.
Galen Bacharier covers Missouri politics & government for the News-Leader. Contact him at [email protected], (573) 219-7440 or on Twitter @galenbacharier.