In another blow for proponents of Medicaid expansion, Cole County Circuit Judge Jon Beetem on Wednesday struck down an effort to expand Medicaid, arguing it was unconstitutional because the 2020 ballot initiative did not include a revenue source to pay for the expansion.
The ruling was in response to a lawsuit filed on behalf of three plaintiffs and 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.
The trial began Monday in an effort to issue a ruling before July 1, in anticipation that the ruling will be appealed by one of the parties.
Beetem declined to order the state to implement Missouri Medicaid expansion, going against the voter’s will.
“The state constitution provides that state revenues may not be expended without an appropriation,” Beetem opined. “Accordingly, this Court declines to order the implementation of Medicaid Expansion as requested in Count 1.”
“Notwithstanding a majority vote of the people, an initiative which does not comply with the limits of constitution cannot stand,” the judge added.
Missouri residents passed Amendment 2, a statewide vote to expand Medicaid health coverage, with 53.25 percent of voters in the August 4 primary casting their ballot in favor of the amendment. By lowering requirement thresholds for Medicaid beginning July 1, an additional 275,000 Missourians who struggle to make ends meet were supposed to have access to health coverage.
“Judge Beetem’s ruling on Medicaid Expansion today is frustrating but we have always known that this case would be decided by the Supreme Court,” Jessica Pace, executive director of Progress MO, wrote in a statement.
Dr. Dwayne Proctor, Missouri Foundation for Health president and CEO, also released a statement shortly after the ruling.
“This decision means that an estimated 275,000 Missourians who qualify under expansion will still have to wait to get the care they need,” Proctor said.
“We are deeply disappointed with today’s ruling and we look forward to the case heading to the Missouri Court of Appeals.”
This ruling is the latest in the state’s Medicaid saga, which began 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 without 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.
“Expanding Medicaid drives economic growth and job creation, creates a more equitable community, and improves the health of Missouri’s workforce,” Jason Hall, CEO of Greater St. Louis, Inc., wrote.
“For these reasons, the St. Louis business community has been a longtime supporter of Medicaid expansion.”
In addition to the ruling, a special session began Wednesday to address the existing Medicaid funding revenue source because the legislature did not reauthorize the medical provider tax, as several GOP members wanted to include language in the bill that bans Medicaid coverage of certain birth control methods.
The Medicaid provider tax in question is collected from hospitals, nursing homes and pharmacies and generates $1.6 billion annually. Missouri then receives an additional $3 billion in federal funds.
If the tax is not renewed, Parson will be forced to make drastic cuts in other areas of the budget to fund the existing program.
Parson met recently with the state Senate Republican caucus. According to The Missouri Independent, the caucus discussed the language that would bar the state from paying for some contraceptive medications and devices and extend the taxes set to expire on Sept. 30 for up to five years.
Some Republican senators are still calling for language that would prevent Planned Parenthood from being a Medicaid provider because of the contraception and reproductive services they offer, however it was not included in the language discussed by the caucus.