Medicaid expansion measure did not violate state constitution, Missouri Supreme Court rules

JEFFERSON CITY, Mo. — In a unanimous decision, the Missouri Supreme Court remanded the Medicaid expansion lawsuit Thursday, ruling the constitutional amendment did not violate the state’s constitution. 

The case was heard earlier this month, with attorney Chuck Hatfield representing three single mothers in the lawsuit and Solicitor General John Sauer representing the state. 

Cole County Circuit Judge Jon Beetem ruled against the lawsuit last month, deeming 2019’s Amendment 2 unconstitutional due to its lack of a stated funding source. However, the state’s highest court said the amendment did not violate the state’s constitution since it did not appropriate money nor remove the General Assembly’s discretion in appropriating funds. 

“An initiative that simply costs money to implement does not necessarily require the appropriation of funds so long as the General Assembly maintains discretion in appropriating funds to implement that initiative,” the decision said. 

The court said the Department of Social Services (DSS) has 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.”

The case has been remanded back to the circuit court which will determine injunctive relief.

“Every judge there agreed on this, which doesn’t happen every day — particularly on big decisions like this,” Hatfield told The Missouri Times. “All of the Supreme Court judges agree that the Missouri Constitution is very clear: We’ve now expanded the Medicaid population by a vote of the people, and it’s clear the legislature has provided funding for Medicaid.”

Hatfield said the next step will be Beetem’s determination of when and how the expansion will take effect. He said all parties would be working together over the coming days to chart a path forward.

Lowell Pearson, who worked with Hatfield on the case, praised the decision.

“The legal team and our clients are very happy with the Supreme Court’s decision today,” Pearson told The Missouri Times. “It very clearly said that 270,000 Missourians are eligible and have to be enrolled in Medicaid and that the legislature did in fact appropriate money for this population.”

Sen. Dan Hegeman, chair of the Senate Appropriations Committee, called the decision “disappointing.”

“Regardless of where one falls on the politics of Medicaid expansion itself, Article III Section 36 gives the General Assembly authority to determine state spending. Judge Beetem, an elected judge, was correct in his ruling,” Hegeman said. “By differentiating between an ‘appropriation’ and an ‘expenditure,’ the Supreme Court is playing political games when common sense says they are both taxpayer dollars. The legal gymnastics employed by the court to get their desired political outcome sets a dangerous precedent and greatly diminishes the power of Missourians’ elected representatives.”

The lawsuit against DSS, Acting Director Jennifer Tidball, and the MO HealthNet Division, among others, was filed in May. It 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.

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. Despite several attempts, the legislature did not approve a dedicated fund before passing its budget.

The expansion was slated to take effect July 1.

Jeremy Cady, the AFP-MO state director, said the Supreme Court has put at risk the “long-term fiscal health of our state.”

“Missouri’s neediest will now face reduced access to care with the legislature stripped of its appropriation authority,” Cady said. “Missouri taxpayers now face potential cuts to education or a tax increase to cover these new costs.”

Yet other organizations, particularly health care groups, praised the Supreme Court’s decision.

“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,” said Amy Blouin, president and CEO of the Missouri Budget Project. “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.”

“The voter-approved Medicaid expansion was supposed to be implemented July 1, 2021,” American Cancer Society Cancer Action Network (ACS CAN) Government Relations Director Emily Kalmer said. “ACS CAN urges officials to take swift action to implement expansion and reduce further delays in care for eligible Missourians. Cancer patients in our state can’t wait any longer for health coverage through Medicaid.”

“The coalition is relieved that every Missourian who is entitled to Medicaid will now be able to enroll. We’re grateful that the Missouri Supreme Court’s unanimous ruling will bring clarity and resolution to this critical issue in which the voters spoke almost a year ago,” Healthcare for Missouri said. “This is not a partisan issue or a political issue — it’s a people issue. The real winners of this legal battle are the people of this state whose livelihoods are dependent on access to health care.”

This is good news for Missourians! Medicaid expansion will move forward as the voters intended. #moleg https://t.co/EAiaig9KFB

— State Senator Greg Razer (@SenGregRazer) July 22, 2021

“Today’s unanimous Missouri Supreme Court decision is a complete vindication for those who have worked to expand health care access and a thorough rejection of those willing to defy Missouri voters and ignore the rule of law to stop it from happening,” House Minority Leader Crystal Quade said of Thursday’s verdict. “We expect the trial judge will follow the Supreme Court’s clear direction and promptly order the state to begin providing Medicaid services to the expanded population as mandated by the Missouri Constitution.”

A spokesperson for DSS declined to comment Thursday.

This story has been updated. Kaitlyn Schallhorn contributed to this report.