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Cole County judge weighing Medicaid expansion timeline


JEFFERSON CITY, Mo. — The next steps for the expansion of the state’s Medicaid population are in the hands of a Cole County judge after the Missouri Supreme Court said the amendment was constitutional.

Attorney Chuck Hatfield implored Cole County Circuit Judge Jon Beetem to order the state to accept applications from the expansion population, noting the high court deemed the language that expanded coverage to be valid and already in effect as of its July 1 effective date. 

Solicitor General John Sauer, who represents the state, said the government needed two months to ensure it had adequate technology to handle the influx of recipients and asked for an additional hearing to allow witnesses from the MO HealthNet and Family Support divisions to testify. Sauer also argued the Missouri Legislature did not appropriate funds for the expansion population, and it was within its statutory power to refuse funding. 

The attorneys made their cases during a hearing Friday afternoon. Hatfield told reporters he expected a decision next week, saying the goal was to implement the Supreme Court’s orders and quickly expand health care coverage. 

“The state and the governor were planning to implement Medicaid Expansion: The people voted for it last year, and the state and executives acted like they were going to implement it all the way until May,” Hatfield said. “They were six weeks from implementation and now they say they need at least another two months to implement it. We don’t think that’s the case.”

Hatfield said he expected the state to follow through on enrolling applicants, though the timeline remained in flux. Gov. Mike Parson told The Missouri Times last week he hoped for a swift solution

“We’ve got to figure out a solution. I don’t think this is something we can sit on for months and say we’re not going to do anything,” Parson said. “It was a unanimous decision on the Supreme Court which pretty well tells you, like it or not, that’s the decision, and we’ve got to figure out how to deal with that.” 

Beetem previously ruled last year’s Amendment 2 was unconstitutional due to the lack of a funding mechanism, an argument often taken by the state and opponents of the measure. The case was appealed to the Missouri Supreme Court, which unanimously ruled in favor of the plaintiffs last month and remanded the case to Beetem. 

The state’s highest court said the Department of Social Services (DSS) had the appropriation authority to provide services for those covered under the expanded Medicaid program and noted the General Assembly “chose against placing conditions or limitations on eligibility for MO HealthNet benefit appropriations in Fiscal Year 2022.”

Members of the legislature sounded off on the Supreme Court’s decision last month, with Appropriations Chair Dan Hegeman calling the ruling “disappointing” while Democratic lawmakers praised the move. The legislature saw a similar split during this year’s legislative session: Despite several attempts, lawmakers did not approve a dedicated fund before passing the state budget.

The lawsuit against DSS, Acting Director Jennifer Tidball, and the MO HealthNet Division, among others, was filed in May on behalf of three single mothers who would be covered under the expansion. It asked the court to find the lack of funding unlawful and sought an injunction to allow the plaintiffs and others who would be eligible to enroll and receive the same treatment as those already covered under the program.

Missourians voted to become the 38th state to expand its Medicaid program in August 2020, moving to cover more than 270,000 people who earn less than $18,000 a year.