A Missouri judge will not force the state to expand its Medicaid program even though Missourians voted for expansion last year. That vote circumvented the GOP-led state legislature that has long been opposed to the measure.
Cole County Judge Jon Beetem said the initiative requires the appropriation of money it did not create. Beetem said the initiative was unconstitutional. "Notwithstanding a majority vote of the people, an initiative which does not comply with the limits of constitution can not stand," Beetem said in his Wednesday ruling.
The ruling comes as a special legislative session convenes in the state to renew an important tax that funds the state's Medicaid program.
In spite of the win at the ballot box in 2020, the Missouri legislature failed to make the funds available to expand the program, known as MO HealthNet in the state, to about 230,000 low-income adults.
In May, Missouri Gov. Mike Parson signed a budget bill that did not include the funds to allow the program to take effect July 1. Parson also sent a letter to CMS in May, notifying the agency that his administration was withdrawing its previously submitted plans to expand the program due to the lack of funding.
"Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed," Parson previously said in a statement.
Missouri was just one of a handful of states that ushered in expansion through a vote of its people. Advocates in Missouri followed the lead of other red states that sought to go around state legislatures to force expansion under the Affordable Care Act. Advocacy groups like the Fairness Project have helped push forward these efforts, with their sights set on new states.
Many southern states still have yet to expand Medicaid, including Florida and Texas.
Expansion extends health insurance coverage to people with incomes of up to 138% of the federal poverty level. An individual who earns less than $18,000 a year would qualify along with a family of four with income of $36,000, according to the Missouri Foundation for Health.
The ruling comes as funding for the state's Medicaid program is already in jeopardy. Missouri relies on a hospital tax to fund its portion of the Medicaid program. The state has failed to pass legislation to renew the tax, a first for the legislative body since the tax was first passed in 1992, according to the Missouri Independent.
Without the tax money from hospitals, the state would then be on the hook for coming up with those funds. Some conservative legislators want to include language that would block Planned Parenthood from receiving Medicaid funds, hampering efforts to reach a deal.
The Biden administration has been pushing for holdout states to implement Medicaid expansion, and Congress included a five percentage point increase in the federal matching rate in the American Rescue Plan.