State seeks two month delay in implementing Missouri Medicaid expansion

(The Center Square) – State attorneys Friday requested a delay of at least two months in implementing the Medicaid expansion that voters approved last August and lawmakers declined to fund until ordered to do so last month by the Missouri Supreme Court.

“We understand that the Missouri Supreme Court’s decision is the law and, in fact, the department is working already to implement it as quickly as it possibly can,” Missouri Solicitor General John Sauer told Cole County Circuit Court Judge Jon Beetem.

Sauer requested another hearing to allow officials from MO HealthNet and the Family Support Division within the state’s Department of Social & Senior Services (DSS) to testify.

Implementing the expansion for an additional 275,000 eligible people “is a complicated process that is already underway, but is going to take more time,” he said.

True, plaintiffs’ attorney Chuck Hatfield told reporters afterward, but the state had a plan in place in mid-May to handle the expansion before withdrawing it when lawmakers adopted a budget that didn’t fund it.

“They were within six weeks of implementation,” he said. “And now they say they need at least another two months to implement. We don’t think that’s the case.”

Last August, Missouri voters approved Amendment 2 with 53% support, expanding Medicaid under the Affordable Care Act.

But Missouri’s Republican-controlled Legislature adopted a $35 billion fiscal 2022 (FY22) budget that did not include about $150 million in state match money to draw $1.9 billion in federal dollars to pay for the expanded coverage under Amendment 2.

Lawmakers contended that Amendment 2 was unconstitutional because Missouri law requires ballot measures that incur expenditures to identify a revenue source to pay for it. Citing that constitutional argument, they decided not to allocate the state match for the federal money.

Attorneys representing three women who would have been eligible for Medicaid under Amendment 2 filed a lawsuit in May citing the Legislature’s decision to not fund Medicaid expansion “despite the clear directive from voters.”

Beetem on June 22 upheld the state’s argument, ruling the amendment could not be implemented without a funding source. But in a unanimous July 22 ruling, the state Supreme Court overturned Beetem’s decision and remanded the case back to him to “issue a judgment for the plaintiffs.”

But that may easier said than done.

Last week, House Budget Committee Chair Rep. Cody Smith, R-Carthage, told reporters he opposes appropriating funding now and expects the state’s Medicaid program to run out of money by year’s end.

“If the department is compelled through judicial action to implement and enroll benefits toward the expansion program, they’re going to have to pay for it out of money appropriated for other populations in the Medicaid program,” Smith said. “That means they will run out of money much sooner than they would normally, and unless they cut Medicaid rates or shoehorn the benefits into the amount appropriated – which means cutting services to someone somewhere – they’re going to have to ask for additional appropriation for additional benefits.”

Gov. Mike Parson has expressed frustration through the whole process. He included state money for Medicaid expansion his budget proposal.

“We’ve got to figure out a solution,” Parson told reporters. “I don’t think this is something we can sit on for months and say we’re not going to do anything. It was a unanimous decision on the Supreme Court which pretty well tells you, like it or not, that’s the decision, and we’ve got to figure out how to deal with that.”

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