Funding for expansion failed to pass in both legislative bodies
In what will now most certainly play out in court, Missouri Gov. Mike Parson formally withdrew the state from its plan to expand Medicaid coverage on Thursday, May 13.
The move came six days after the General Assembly presented him with the 2022 budget that did not include the $1.9 billion for Medicaid expansion — something he reluctantly requested be included to respect the will of the voters.
“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” Parson said in a news release. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our state plan amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”
Missouri residents passed Medicaid expansion with 53.25 percent of the vote on Aug. 4. By lowering requirement thresholds for Medicaid beginning July 1, an additional 275,000 Missourians who struggle to make ends meet will have access to health coverage.
Robin Rudowitz, Kaiser Family Foundation vice president and co-director for the Program on Medicaid and the Uninsured, confirmed that Missouri is the only state to withdraw plans to expand Medicaid once they had been implemented.
There are 12 states who have not moved to expand Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming.
“Among the 12 that haven’t expanded there’s certainly been large party line divisions in terms of favoring versus not favoring expansion,” Rudowitz said.
Parson noted that prior to the August 4 vote, the Missouri Court of Appeals Western District issued an opinion in June 2020 stating that the expansion ballot initiative did not create a revenue source or direct the General Assembly to appropriate funds, and so the General Assembly retained discretionary authority to fund or not fund MO HealthNet expansion if the ballot initiative passed.
Most experts agree that the expansion would cost the state almost nothing when factoring in federal monetary incentives.
Missouri Sen. Karla May, D-St. Louis, serves on the Senate’s Appropriations Committee, which was tasked with drafting the Senate’s version of the state’s multi-billion dollar operating budget for the next fiscal year.
While May disagrees with Republicans’ interpretation of the law, she believes that withdrawing from the plan may be the best course of action for those who would be eligible for coverage under the new requirements.
“Nothing is a surprise to me, but all I think this does is speed up the process for a court case,” she said.
May added: “I think it gets people where they need to be because I think that people need coverage right now and I think that hurrying the process along will help them get to where they need to be.”
Amy Blouin, founder and CEO of the Missouri Budget Project, agreed, in part. She said this move by Parson will allow proponents of the expansion to bring the matter to court sooner than its July 1 implementation date — but she’s not sure the process will move any quicker.
“I think people should fight to enforce their constitutional rights and we are going to stand by them and continue to fight with them.” —Richard von Glahn, policy director at Missouri Jobs with Justice
“The people of Missouri voted for this, and we believe that regardless of [Parson’s withdrawal] we will be implementing Medicaid expansion,” she said. “We believe that the courts are obviously going to need to get involved and that the courts will agree that Medicaid expansion must be implemented.”
The expansion would cover working-age adults who earn up to 138 percent of the federal poverty guideline, or $17,774 a year for a single person. That is equal to working about 33 hours a week at the state minimum wage of $10.30 per hour.
For a household of four, the limit is $36,570, the income of one person working full time at $17.58 an hour or two people working a combined 68 hours a week at minimum wage.
Richard von Glahn, policy director at Missouri Jobs with Justice, said Parson is betraying the voters by going back on his word.
“And instead, he is attempting to hide behind politicians and keep this from moving forward.,” von Glahn said. “But politicians don’t get to change the constitution, they don’t get to amend the constitution, and the voters spoke, and the constitution is still in effect.”
He also wanted people to know that Jobs with Justice and other organizations will stand behind them in order to ensure their constitutional right to Medicaid coverage is respected.
“I think people should fight to enforce their constitutional rights and we are going to stand by them and continue to fight with them,” von Glahn said.
In April, House Republicans took a stance against the expansion by removing its funding from the upcoming fiscal year’s general budget, arguing that there’s no money for it.
But that’s just not true, according to Blouin and Rudowitz — who said other states which have already expanded Medicaid under the Affordable Care Act have provided data on how it’s played out financially for their budgets.
In addition to the federal funds that would cover 90 percent of the expansion under the Affordable Care Act, the state should receive about $2.8 billion in American Rescue Plan Act federal funding.
Essentially, Rudowitz said, Medicaid expansion is a net fiscal benefit.
Following the House’s decision, the Missouri Senate voted 14-20 to also exclude expansion funding in the budget bill presented to Parson for approval.
Without expansion, Missouri has one of the most restrictive Medicaid eligibility levels for parents in the nation and altogether excludes childress adults. As it stands, the program provides coverage for parents earning no more than $388 per month for a family of three, the lowest level allowed under federal law and the third-lowest eligibility level in the nation.
