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Judge hears arguments in Medicaid expansion suit; decision expected this week

JEFFERSON CITY, Mo. — After months of debate in the legislature, a lawsuit over the state’s lack of funding to expand Medicaid coverage went to court Monday with a decision expected as early as this week. 

Cole County Circuit Judge Jon Beetem heard arguments on the case Monday afternoon. Beetem noted the expansion has an effective date of July 1, and the delay in the proceedings due to Friday’s Juneteenth holiday further hurried the process. He said he was likely to hand down a decision by Wednesday. 

Attorney Chuck Hatfield argued the case on the behalf of the three plaintiffs, positing the state was attempting to alter eligibility guidelines through an appropriation bill rather than by a constitutional amendment such as the way Clean Missouri was altered once more last year. He also said the appropriations by the legislature covered the extent of the eligible population, not just those who were already covered. 

“There’s money that has been appropriated for Medicaid services. Once that’s done, those folks are eligible under the constitution,” Hatfield told reporters following the hearing. “There’s no expansion population: We had an election about that, we voted to amend the constitution. … There is no such thing as the expansion population or the preexisting population, there is just Medicaid coverage, and our plaintiffs are in that group.”

Hatfield said he expected the court’s decision to be appealed. 

Attorney D. John Sauer represented the state Monday, arguing the texts of this year’s appropriations bills pointed to the preexisting population and emphasizing a provision in the Department of Social Services (DSS) appropriation bill that held funds could only go to “the item or items  stated, and for no other purpose whatsoever.”

“There was a whole series of intense debates in the legislature about this,” he said. “At the conclusion of this process, all of the reasonable participants in the process — the governor, legislators who supported expansion, legislators who opposed it — all thought they hadn’t funded Medicaid expansion.”

The suit against DSS, Acting Director Jennifer Tidball, the MO HealthNet Division, and the Family Support Division, among others, was filed last month on behalf of three single mothers who would be covered under the expansion. The lawsuit asked the court to find the lack of funding for the expansion 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. 

The battle has drawn the attention of groups on both sides of the issue; Healthcare for Missouri, the group that backed the ballot initiative, applauded the issue’s first steps in court. 

“Today’s hearing marks another step forward in ensuring that more than 275,000 Missourians can enroll in and receive benefits under the Medicaid program. Voters spoke loud and clear in favor of Amendment 2 last August,” the group said in a statement. “The focus now must be on the people who deserve to have access to health care on July 1. The constitution is clear: Individuals eligible for Medicaid as a result of Amendment 2 cannot be treated differently. Our coalition remains confident that the courts will uphold that position.”

Missourians voted to become the 38th state to expand its Medicaid program last August, moving to cover more than 200,000 people who earn less than $18,000 a year. Despite various attempts, the legislature did not approve a dedicated fund.