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Missouri does not need to expand Medicaid program July 1, judge rules

  

JEFFERSON CITY, Mo. — Cole County Circuit Judge Jon Beetem said Missouri is not obligated to expand Medicaid coverage on July 1.

“Having fully considered the parties’ pleadings, evidence, and written and oral arguments, the Court concludes that the state’s refusal to enroll plaintiffs and other eligible individuals in the MO HealthNet program is not unlawful,” the decision read. “Notwithstanding a majority vote of the people, an initiative which does not comply with the limits of [the] constitution cannot stand.”

Attorney Chuck Hatfield, who represented the three plaintiffs, said an appeal was imminent. 

“As all observers predicted, the issues around Medicaid expansion will be decided in the Court of Appeals. We are disappointed in today’s ruling, but believe the Court of Appeals will disagree,” Hatfield and partner Lowell Pearson said in a statement. “We will immediately appeal this decision to the Court of Appeals for the Western District of Missouri.”

Beetem wrote the expansion would be appropriate had Amendment 2 been “validly enacted,” but said the amendment affect the legislature’s control over appropriations. He returned to the oft-cited argument of a lack of a stated funded mechanism, declaring the ballot measure unconstitutional. The plaintiffs’ request for declaratory and injunctive relief were denied. 

The statutory effective date for the expansion is July 1, the start of the new fiscal year.

The Attorney General’s Office declined to comment since an appeal was likely.

Beetem heard arguments on the case Monday afternoon. Hatfield argued 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.”

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.

“We are deeply disappointed with today’s ruling against Missourians and their constitutional right to Medicaid coverage. It is unfortunate that, yet again, hundreds of thousands of Missourians will have to wait even longer to access the health care they need,” Missouri Foundation for Health President Dr. Dwayne Proctor said in a statement. “The sooner the state implements expansion, the sooner the state will reap the economic and budgetary benefits that are well documented. But most importantly, more Missourians will be able to access health insurance to get and stay healthy, remain in the workforce, and support their families.”

“This year alone, 37,390 will hear the words ‘you have cancer’ and 12,960 Missourians will pass away from cancer. None of them should suffer a day without the Medicaid healthcare coverage that a majority of Missourians voted into the Missouri Constitution,” American Cancer Society Cancer Action Network (ACS CAN) Government Relations Director Emily Kalmer said. “ACS CAN will continue to advocate on behalf of cancer patients to ensure that they are able to access the coverage guaranteed to them by our state’s constitution.”

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.

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This is a breaking news story and will be updated.