Missouri Supreme Court Upholds State’s Medicaid Expansion

The Missouri Supreme Court on Thursday reversed a lower court decision that had found the state’s voter-approved Medicaid expansion unconstitutional.

In an expedited ruling, the state’s high court said Cole County Circuit Judge Jon Beetem erred when he determined that the August 2020 referendum was fatally flawed because it didn’t include a funding source.

The high court sent the case back to Beetem, who is expected to order the state to begin making arrangements to enroll as many as 275,000 Missourians with low incomes in Medicaid even though lawmakers chose not to include the estimated cost in the state’s 2022 budget. Originally, the expansion was to have taken effect July 1.

The state’s share of the estimated $1.9 billion cost of the expansion would be about $120 million, with the federal government ponying up the rest. The expansion makes all adults below certain income thresholds eligible for Medicaid, the health plan for lower-income Americans.

Healthcare for Missouri, a coalition of organizations that campaigned in favor of the referendum, celebrated within moments of the ruling.

“The coalition is relieved that every Missourian who is entitled to Medicaid will now be able to enroll,” the group said in a statement. “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.”

The referendum passed with more than 53% of the vote.

The legal case came after the Republican-led legislature in May voted against funding the voter-approved expansion, prompting Republican Gov. Mike Parson to pull back an application with the federal government that would have formalized the expansion.

The lawsuit was brought by three low-income women who argued that the budget approved by lawmakers did not explicitly say Medicaid expansion was prohibited and they were therefore entitled to enroll.

Siding with the state, Beetem, the lower court judge, agreed that the Missouri Constitution prohibited voter-approved measures from creating new programs without funding. The plaintiffs countered that the referendum didn’t create a new program but simply expanded an existing one that the legislature was required to fund.

Counting Missouri, 38 states and Washington, D.C., have expanded Medicaid.