UPDATE: Aug. 11, 2021: A Missouri judge on Tuesday ordered the state to begin enrolling people newly eligible for Medicaid without imposing any further restrictions on eligibility.
- Missouri's highest court ruled Thursday that the state must expand Medicaid coverage to about 275,000 people, overturning a lower court ruling that found the voter-backed initiative in 2020 was unconstitutional.
- In a unanimous ruling, the court said the ballot amendment voters approved in 2020 to expand the program to more people does not appropriate money — unlike the ruling in the lower court — and instead directs the state to recognize and cover an additional category of low-income people for insurance coverage. Because the state legislature already appropriates funds for Medicaid, it cannot discriminate against, or pick and choose, who is eligible to receive those funds for coverage.
- Proponents of Medicaid expansion cheered the news Thursday following a long battle to secure Medicaid expansion in the state.
Thursday's ruling delivers a decisive victory for Medicaid expansion proponents. It also marks another victory via a ballot box strategy. In some red states, proponents have chosen to circumvent state legislatures, which have refused to expand the program, by putting a vote to the people.
Missouri voters approved an amendment to the state's constitution in 2020, paving the way for adults without children and incomes at or below 138% of the federal poverty level to gain coverage starting July 1 through the state's Medicaid program, known in Missouri as Mo HealthNet.
But in May, Missouri Gov. Mike Parson sought to withdraw previously submitted plans with federal regulators to expand the program. In a letter, Parson told regulators Missouri did not appropriate new funds for the expansion population and had no means to fund the newly eligible, essentially blocking coverage from going into effect July 1.
Three Missourians eligible for coverage under expansion filed suit. They lost in a lower court after a judge ruled the amendment requires an appropriation of money it did not also create.
But the state Supreme Court found that the state already appropriates funds for Mo HealthNet.
"This was one of presumably thousands of difficult decisions made each year during the appropriation process," the court said.
And because the state appropriates money to the Medicaid program, it must now recognize and spend the funds on the newly eligible.
"It means that the will of the voters was upheld, and that for low-income individuals, protected by the Missouri constitution, have a right to Medicaid coverage if they're eligible. That the constitutional provision is valid and that the state cannot discriminate between the new eligibility group and previous eligibility groups," Joel Ferber, an attorney for the plaintiffs, said.
The Fairness Project, a D.C.-based advocacy group, has helped launch ballot initiatives on key issues like Medicaid expansion in various states, including Missouri.
Executive Director Kelly Hall said Thursday's ruling is a "joyful relief" for those eligible for coverage under expansion.
"It's also a huge relief to Missourians as voters because yesterday's ruling demonstrates that the will of the people matters," Hall said.