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Missouri governor drops voter-approved Medicaid expansion

The decision is likely to trigger a lawsuit from supporters of Medicaid expansion

JEFFERSON CITY, Mo. — Missouri Gov. Mike Parson dropped plans Thursday to expand the state's Medicaid health care program to thousands of low-income adults after the Republican-led Legislature refused to provide funding for the voter-approved measure.

The Republican governor said his administration had withdrawn a request to expand coverage that had been submitted to the federal Centers for Medicare and Medicaid Services in compliance with a constitutional amendment passed by voters last August.

He noted that the state's $35 billion budget approved by lawmakers last week didn't provide the funding he had requested for an expansion of Medicaid, which is known is Missouri as MO HealthNet.

"Without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri’s existing MO HealthNet program remains solvent,” Parson said Thursday.

The decision is likely to trigger a lawsuit from supporters of Medicaid expansion.

“This is going to end up in court — the governor knows it’s going to end up in court,” said Richard von Glahn, policy director for Missouri Jobs With Justice, one of the organization supporting Medicaid expansion.

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Missouri Hospital Association spokesman Dave Dillon expressed disappointment over Parson’s decision and said the association would coordinate with other Medicaid expansion supporters about the best way to proceed with litigation.

Democratic lawmakers denounced Parson's decision. House Minority Leader Crystal Quade said Parson had broken his promise to uphold the constitution. Senate Minority Leader John Rizzo said in a written statement that the governor was “caving to the new Authoritarian Republican Regime that doesn't respect the outcome of elections.”

Though the federal government would fund the vast majority of a Medicaid expansion, some Republican lawmakers said the state cannot afford its share of the long-term costs under the terms of a law signed by President Barack Obama in 2010.

The constitutional amendment passed by voters required Parson's administration to submit a plan to federal officials to expand Medicaid by March 1, which he did. The ballot measure stated that people ages 19-65 earning up to 138% of the federal poverty level — less than $17,774 annually for an individual or less than $37,570 for a family of four — “shall be eligible” and “shall receive coverage” for Medicaid benefits starting July 1.

The amendment did not change existing eligibility standards for children and seniors, and it did not say how to pay for the expansion that is projected to cover about 275,000 people.

Parson had opposed Medicaid expansion at the ballot box, but he said he would uphold the will of voters and so included $1.9 billion in federal and state funding for it in the budget he proposed to lawmakers earlier this year.

While dropping the expansion plan Thursday, Parson referenced a June 2020 state appeals court ruling that the ballot measure didn't direct or restrict the Legislature's ability to decide how to fund Medicaid.

Although the Legislature didn't include specific funding for the expansion, Democrats and some health care advocates contend the additional low-income adults could be covered from the general pool of funds that was allotted for Medicaid.

“Cancer patients cannot wait for legal battles to access the life-saving coverage that Medicaid expansion provides,” said Emily Kalmer, the Missouri government relations director for the society's Cancer Action Network.

The Legislature's refusal to add money for the Medicaid expansion is not the first time that Missouri lawmakers have sought to undo measures passed by voters. Last year, legislators placed a measure on the ballot to reverse key parts of a redistricting measure approved by voters in 2018. Voters approved the lawmakers' revised version. A decade ago, the Legislature also revised a voter-approved measure imposing regulations on dog-breeding businesses.

Missouri Budget Project, a nonprofit organization that analyzes state budget, tax and economic issues, also weighed in on the news Thursday.

"We’re extremely disappointed that Missouri policymakers continue to ignore the will of Missourians – especially with baseless claims about the fiscal impact of expansion. State after state has shown that Medicaid expansion is an economic benefit for states. Not only do states save money on existing health services, but federal funds from expansion create jobs and increase economic activity, generating additional tax revenue to fund the state’s share of expansion. No state has had to raise taxes or cut services to pay for it. Medicaid expansion will move forward in Missouri, but Missourians shouldn’t have to wait – yet again – to see the benefits expansion will bring our state," Missouri Budget Project President and CEO Amy Blouin wrote in an emailed statement.

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This story has been corrected to indicate that the ballot measure vote was in August, not November.

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