Natasha Pickens

Natasha Pickens, President of Communications Workers of America 6355, who represents the Missouri public sector workers, including Department of Social Services and the Department of Health, spoke on the importance of making sure the governor knows that we want to keep the expansion in place on Fri. May 14, 2021, at the Missouri Department of Social Services. 

In an unusually fast turnaround, the Missouri Supreme Court on Thursday issued a unanimous ruling reversing a lower court’s decision that found the effort to expand Medicaid in the state was unconstitutional. 

The initial lawsuit was filed on behalf of three plaintiffs which sought an order for the Department of Social Services to allow all who are newly eligible to enroll and receive the same coverage as current program clients beginning July 1, even though the state legislator and Missouri Gov. Mike Parson failed to include money in the state’s budget to pay for the expansion costs. 

Parson also withdrew the state from its plans to expand the program.

Cole County Circuit Judge Jon Beetem on June 25 struck down an effort to expand Medicaid in response to the lawsuit. He argued it was unconstitutional because the 2020 ballot initiative did not include a revenue source to pay for the expansion.

Attorneys for the plaintiffs appealed the ruling. 

“Because [the expansion amendment] does not appropriate money and does not remove the General Assembly’s discretion in appropriating money to MO HealthNet, the circuit court erred in declaring [the expansion amendment] constitutionally invalid,” the Supreme Court judges wrote in their opinion. 

“Unanimous is a cool way to win,” Chuck Hatfield, an attorney for the plaintiffs and former chief of staff to Democratic Attorney General Jay Nixon, tweeted shortly after the opinion was released. 

The case will now return to Beetem where he will decide whether those eligible under the expansion may enroll even while the state’s budget does not include the funding needed to provide services to the approximately 275,000 Missourians who will become newly eligible. 

Several proponents of expansion spoke out Thursday afternoon in response to the ruling.

Dr. Dwayne Proctor, president of the Missouri Foundation for Health, said in a statement that his organization looks forward to working with the state’s leaders and committed partners to move ahead with full implementation to ensure that those who are eligible know about expansion, how to enroll and where to access care.

“This marks a significant step toward achieving health equity and ensuring that individuals and families have access to affordable, high-quality health insurance,” he said.  

U.S. Rep. Cori Bush, D-St. Louis, wrote in a statement that this ruling marked a monumental and resounding victory for the country’s democracy. 

“The unanimous Missouri Supreme Court decision to defend the voice of the people is a clear rejection of state Republicans’ attempts to dismantle our democracy and undermine public health,” Bush wrote. “This decision must be respected, and Medicaid expansion must finally and fully be implemented and provided for the almost 300,000 people across the state who will now have health coverage.”

Jessica Pace, executive director of Progress MO, wrote that it was time the governor and Missouri GOP member fulfilled their oath of office by funding the program.

 “Missourians have fought for decades to expand eligibility for Medicaid so that our family members, friends, and neighbors can receive the care they deserve without making hard decisions between going to the doctor or putting food on the table,” she wrote. 

Amy Blouin, president & CEO, Missouri Budget Project, added: “As a result of the Supreme Court’s ruling, Missourians across the state will finally be able to realize the health and economic benefits of Medicaid expansion. State after state has shown that in addition to providing insurance to those eligible, expansion is a fiscal and economic boon to state economies and budgets.”

“For far too long, we’ve seen the devastating impact on patients — disproportionately women, people of color, and people in rural communities  — when they fall into the Medicaid gap,” wrote Yamelsie Rodríguez, president and CEO, Planned Parenthood of the St. Louis Region and Southwest Missouri. “Many delay care or cannot access it altogether. We look forward to jump starting Medicaid enrollment and ensuring every person who qualifies can afford the health care they need and deserve. This is what health equity and justice look like.”

Jason Hall, CEO of Greater St. Louis, Inc. wrote that expanding Medicaid expansion is a pro-growth public policy that supports better health outcomes, creates jobs and promotes racial equity.

“It is hard to overstate the positive impact this decision will have on economic growth across the state of Missouri,” he said. “The state is expected to see a substantial increase of new high-quality jobs. More hard-working families will have access to health care. Our health care sector will be able to expand and hire more people in more places.”


This is just another chapter in the Medicaid expansion saga, which began in April when House Republicansresisted the will of the voters by removing $1.9 billion allocated for the program’s July expansion when crafting the 2022 state budget. 

TheSenate then also voted against funding the program expansion.

Six days after the General Assembly presented Parson with the 2022 budget sans the expansion funding,the governor withdrew the state from its plan to expand Medicaid coverage altogether.

Protests across the state were held following the announcement. Shortly after, proponents took the matter to court.

Meanwhile, Parson warned that if the legislature does not reauthorize the medical provider tax, he could be forced to take a knife to the 2021-22 budget to fund the state’s Medicaid program. 

The Medicaid provider tax is collected from hospitals, nursing homes and pharmacies and generates $1.6 billion annually. Missouri is then eligible to receive an additional $3 billion in federal funds. 

Parson called the special session because the legislature did not reauthorize the FRA (medical provider tax), as several GOP members wanted to include language in the bill that bans Medicaid coverage of certain birth control methods and blocks government funding of Planned Parenthood.

The tax bill was then passed without the amendments regarding birth control and abortion.

Prior to the expansion, Missouri had one of the most restrictive Medicaid eligibility levels for parents and childless adults in the nation, according to the Missouri Budget Project. As it stood, the program provided coverage for low-wage parents earning no more than $388 per month for a family of three, the lowest level allowed under federal law.

Missouri residents passed Medicaid expansion with 53.25% of the vote Aug. 4

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