Judge Rules Against Medicaid Expansion In Missouri, Decision Will Be Appealed

Jun. 23—Missouri's voter-approved Medicaid expansion is unconstitutional because it infringes on lawmakers' authority over spending, a state judge ruled Wednesday in a decision that will be appealed.

Gov. Mike Parson's administration isn't required to extend health coverage to roughly 275,000 low-income MIssourians, Cole County Circuit Judge Jon Beetem found in his decision. Expansion supporters had hoped he would order the state to implement the program beginning July 1, even though the Republican-controlled General Assembly refused to fund it.

Beetem wrote that under the Missouri Constitution, the public "may only spend or appropriate the revenues that they raise in the initiative."

"If the Court allows them to spend other state revenues by initiative, such action would deprive the General Assembly of its constitutional right to appropriate revenues in all other non-initiative circumstances," he wrote.

Parson scuttled the expansion in May after lawmakers refused to budget funds for the new patients, prompting a lawsuit from three low-income women who will qualify for the program when the new rules begin July.

The plaintiffs on Wednesday promised a swift appeal.

"As all observers predicted, the issues around Medicaid Expansion will be decided in the Court of Appeals," Chuck Hatfield, an attorney for the plaintiffs, said in a statement. "We are disappointed in today's ruling, but believe the Court of Appeals will disagree."

Hatfield said the judge found that the initiative was not validly enacted because it used the initiative process to appropriate funds. "This is not an issue the State raised or argued at trial," he said.

The case hinged on whether the state must enroll Medicaid recipients under the new eligibility rules without lawmakers budgeting money specifically for that purpose. Beetem's decision — that the initiative curtailed the spending power of the General Assembly — echoed arguments Republicans had made in refusing expansion funding.

Attorney General Eric Schmitt's office didn't immediately comment. "You can't force an appropriation in a ballot measure," James Harris, a Jefferson City-based Republican consultant, wrote on Twitter.

Parson's administration estimated the expansion would cost $130 million in state funds for the first fiscal year. That would come with $2 billion from the federal government. Republican lawmakers balked at the cost and repeatedly voted that funding out of the budget that will take effect in the new fiscal year beginning July 1.

Beetem wrote that the state's refusal to enroll eligible individuals "is not unlawful."

"Notwithstanding a majority vote of the people, an initiative which does not comply with the limits of constitution can not stand," he wrote.

In a Monday hearing, the state, represented by solicitor general Dean John Sauer, argued that lawmakers, in the budget they passed, clearly intended to pay only for traditional Medicaid recipients and not the "expansion population."

Hatfield argued that it did not matter, because the lawmakers passed a budget with money for Medicaid as a whole and the state must use the existing funds budgeted to allow everyone who is eligible to be covered.

"There is no pre-expansion population or expansion population, there is only eligible Medicaid members," Hatfield said.

Enrolling the new recipients would doubtless cause the state to run out of money in its Medicaid budget partway through the year, potentially setting up another legislative fight over funding for an expanded population.

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.

She 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.

The Star's Bryan Lowry contributed reporting

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