Litigation no surprise after Parson withdrew voter-approved plan
Coming as no surprise, attorneys filed suit Thursday on behalf of three plaintiffs seeking to compel Missouri to implement Medicaid expansion July 1, as passed by voters in August 2020.
The lawsuit seeks an order for the Department of Social Services to allow the three women, and all who are newly eligible, to enroll and receive the same coverage as current program clients beginning July 1.
Missouri Gov. Mike Parson formally withdrew the state from its plan to expand Medicaid coverage 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.
Republican senators and representatives 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.
“We are confident that the courts will uphold the people’s vote in support of Medicaid expansion.”
– Missouri Budget Project President and CEO Amy Blouin
However, most experts agree that the expansion would cost the state almost nothing when factoring in federal monetary incentives.
In the lawsuit, the attorneys argue the legislature has appropriated money for services provided by Medicaid and, come July 1, those who qualify to enroll under the expansion can do so — and it will remain to be seen whether there is enough money to cover those services for all enrollees.
“In most years, the DSS appropriations bill does not include sufficient appropriation authority for the MO HealthNet program for the entire fiscal year. The General Assembly cannot predict with certainty the number of individuals who will enroll in MO HealthNet during the next fiscal year or the health needs that those individuals will have during the next fiscal year. Thus, it is impossible for the General Assembly to appropriate precisely the amount of funds needed to fund MO HealthNet for the entirety of the next fiscal year,” attorneys wrote in the lawsuit.
The lawsuit, filed in Cole County Circuit Court, includes three plaintiffs who “face serious and often chronic medical challenges” and who currently lack access to health care “that, in some cases, is a question of life and death.” All three — Stephanie Doyle, Melinda Hille and Autumn Stultz — would be eligible to enroll for Medicaid under the expansion.
Doyle is a single mother working full-time for $12 an hour and her three children are enrolled in Medicaid. However, she doesn’t qualify for coverage herself and this leaves her to pay out-of-pocket for her hospitalizations and medications to treat her eczema.
Hille is unable to work due to her medical conditions and has no income, however she was still not qualified for coverage under the current eligibility requirements. She suffers from Type 1 diabetes, thyroid disease, pernicious anemia and a precancerous growth on her colon.
Stultz is a single mother working part-time for minimum wage and has a daughter enrolled in the state’s Medicaid program, Mo HealthNet. Under the expansion, Stultz would finally be eligible for coverage and have access to treatment for her chronic asthma and surgery to remove tonsil stones.
“Missouri legislators funded Medicaid in the state budget, and it’s clear that implementation can proceed for July 1st as planned,” said Missouri Budget Project President and CEO Amy Blouin in a statement. “Simply put, Missouri funds the health services provided through Medicaid – it does not fund specific population groups. While next year’s state budget doesn’t have a line item for Medicaid expansion adults, it doesn’t have line items for pregnant women, children, or people with disabilities either. Whoever is eligible for Medicaid can be enrolled and receive services.”
The legal team who filed the lawsuit consists of Chuck Hatfield, former chief of staff to Democratic Attorney General Jay Nixon; Lowell Pearson, former general counsel to Republican Gov. Matt Blunt; and Joel Ferber, director of advocacy of Legal Services of Eastern Missouri.
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.
“We are confident that the courts will uphold the people’s vote in support of Medicaid expansion. After years of delay, we look forward to our state being able to finally experience the many health, economic, and budget benefits of expansion,” Blouin said.
Because expansion was not implemented prior to the American Rescue Act, Missouri should receive about $2.8 billion in federal funding.
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.
Without expansion, Missouri has one of the most restrictive Medicaid eligibility levels for parents and childless adults in the nation, according to the Missouri Budget Project. As it stands, the program provides coverage for low-wage 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.
