UPDATE: May 21, 2021: Three plaintiffs have filed suit against Missouri for failing to expand Medicaid to its adult population. A lawsuit was expected as the Republican-controlled legislature failed to allocate additional funds for the program after voters approved the ballot initiative last year. The lawsuit was filed Thursday by three Missouri residents who are eligible for expansion coverage.
Advocates applauded the litigation. “It’s time for the political stunt in Missouri to come to an end,” said Jonathan Schleifer, executive director of The Fairness Project, a group that has helped organize ballot-led Medicaid expansion efforts in a number of red states.
Missouri is withdrawing plans to expand Medicaid coverage to its low-income adult population after the Republican-controlled legislature failed to allocate funds for the voter-backed initiative.
Missouri Gov. Mike Parson, a Republican, sent a letter to the CMS on Thursday alerting the federal agency that his administration is now withdrawing the state plan amendment it submitted earlier this year, which is required to expand the Medicaid program to roughly 230,000 Missourians.
The issue is almost certainly headed for legal battle in court after Thursday's news sparked an outcry from Medicaid advocates. Voters approved Medicaid expansion in the state last year, circumventing the GOP-led state legislature that had refused to allow more adults without children to gain coverage by expanding the program.
Last week, the state legislature passed a budget without earmarking funds to expand the Medicaid program, known as MO HealthNet in Missouri. Parson signed that budget bill Thursday.
"Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed," Parson said in a statement Thursday. But without a funding source, Parson said he's unable to proceed.
The Missouri Hospital Association said it was disappointed by the news, and noted the issue is likely to be decided by the courts. The lobby called the lack of action by lawmakers an "affront" to voters.
MHA also pointed out that state is sitting on several billion in federal funds from various relief packages over the past year that it could use to pay for the program.
"Amid a pandemic, access to health care has never been more important. Missourians understood this in August 2020," when the measure was approved, the group said in a statement.
Expanding Medicaid coverage was a key component to former President Barack Obama's signature health law, the Affordable Care Act. After a legal battle that reached the Supreme Court, the justices said states were allowed to decide whether they want to expand the government-sponsored insurance program to include more adults that had previously been ineligible for coverage.
Medicaid is funded in part by both the state and federal government. In Missouri, the hospitals play a key role in drawing down federal funds to help pay for the program. The state's hospitals essentially pay a provider tax to create a pool of money that is than used earn federal matching funds, helping alleviate the funding burden for the state.
For the expansion population, the federal government is largely on the hook financially, and the matching rate was increased recently under the American Relief Plan.
Yet, many southern and red states have held out on passing such an initiative. To get around GOP-controlled legislatures that refused to expand, some states, including Missouri, took the issue straight to the ballot for voters to decide themselves. Advocacy groups like the Fairness Project have helped organize some of those efforts.
"Missouri's constitution is crystal clear: Medicaid expansion must begin on July 1," Jonathan Schleifer, executive director of The Fairness Project, said in statement.
"Missouri voters had the good sense to guarantee healthcare for their neighbors in the state constitution so that lifesaving care would no longer be subject to the whims of partisan politicians," Schleifer added.