Medicaid expansion a waiting game after Missouri Supreme Court ruling

Jul. 24—Some local residents this week were excited to learn that the Missouri Supreme Court essentially upheld a voter-approved expansion of Medicaid. But people hoping to enroll in that program still have a waiting game ahead of them.

On Thursday, the Missouri Supreme Court vacated a county court's decision last month to overturn a constitutional amendment approved by voters last August. The amendment's directive to expand Medicaid enrollment was not funded by the Republican-led Legislature in the state budget for the current fiscal year, which began July 1, the same day expansion of the health care program was to become effective.

The ruling was appreciated by many supporters of last year's election measure, including Reannon Stark, 21, of Webb City. The single mother of two children said she cannot afford the insurance offered by her employer.

"It means a lot to me," Stark said. "I don't really ever go to a doctor when I have issues, because I can't afford it. I work while sick a lot, which I shouldn't, but I don't have a choice."

But Thursday's ruling does not guarantee a speedy implementation of the expansion. The Supreme Court's unanimous decision returns the case back to Cole County Circuit Court.

State Rep. Cody Smith, R-Carthage, said the state is now in a waiting game to see whether the courts will order the expansion to be funded.

"The executive branch is looking to the courts now," Smith said. "We have been talking with the governor and his staff about how we move forward in the state. ... That could include a special session, or we deal with this once we get to the next session in January."

The Medicaid expansion constitutional amendment passed with a 53% statewide majority last August. The expansion was expected to add Medicaid eligibility for up to 275,000 low-income Missourians.

Gov. Mike Parson allocated money in his fiscal year 2022 budget to finance the expansion. But Smith, chair of the House Budget Committee, said the Legislature did not fund that expansion based on what he said was a lack of a funding mechanism in that August amendment — a violation of Missouri's constitution, Smith said.

Funding for normal annual expenditures of Mo HealthNet, what Missouri calls its Medicaid program, was included in the budget.

Thursday's court decision stems from a lawsuit filed on behalf of three women who are eligible for Medicaid under the expansion. According to the Supreme Court justices, the expansion did not violate the state's constitution because it "does not appropriate money and does not remove the General Assembly's discretion in appropriating money" for it.

Smith said despite the ruling, he continues to have concerns about the long-term budget impact of last year's constitutional amendment. While the expansion of Medicaid comes with a 90% match from the federal government, that concern led to lawmakers not funding the expansion.

Services to people with disabilities, or who are blind or elderly, and other people unable to work could be at risk to fund an expansion that could be used by any able-bodied person of virtually any age, Smith said.

"The Medicaid program is already quite large and quite expensive, and gets more so each year," Smith said. "To add enrollees to that program ... I have concerns about what other things will suffer in the budget to accommodate that."

The delay leaves people such as Stark continuing to wait. As Stark volunteered on the campaign to pass the amendment last year, she met a lot of people in situations just like hers, she said.

"There were more than I can count, especially people close to my age," Stark said. "Other full-time workers like me are in the exact same boat as me."

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