Missouri will not be implementing Medicaid expansion on July 1st, and the question of when it eventually happens, or if it happens at all, appears destined for the courts.
In August, Missouri voters approved Medicaid expansion through a constitutional amendment. Recently, Missouri’s legislature passed next year’s budget sans funding for Medicaid expansion. As I wrote more than a month ago, the state’s general assembly had real reasons for deciding against funding expansion. Medicaid expansion represents a significant growth in future spending obligations for the state’s budget. Despite claims to the contrary, expansion was set to cost more than $1.5 billion next year, with approximately $100 million coming from state sales and income taxes that would normally go toward other programs.
Missouri’s constitution gives the legislature the sole responsibility of authorizing state spending. Further, it states that constitutional amendments cannot impose new costs without outlining how that cost would be paid for. Since the amendment approved by voters last August has proven to have an enormous price tag, and included no funding mechanism, the legislature decided not funding expansion was a constitutionally valid option.
After the budget was approved, several legislators noted the constitutional amendment still requires eligibility guidelines to be expanded on July 1st, regardless of whether there is funding to cover the cost. Recently, the state’s Medicaid agency began laying the regulatory groundwork for eligibility expansion. But last Thursday, Governor Parson tore up that groundwork and withdrew the proposed changes that would expand eligibility on July 1st. In the statement announcing withdrawal, the governor’s cited reason was the lack of budgeted funding.
Heading into the new state fiscal year, there’s only one thing about Medicaid expansion that’s certain: it will not be happening in Missouri on July 1st. Expansion advocates aren’t going to just sit back and let this go, which is why a legal challenge appears imminent. It’s likely the next step is for someone to be denied coverage who would have qualified under the approved constitutional amendment after July 1st, which will prompt a lawsuit and send the issue to the courts. Judges will have to decide not only whether an amendment can compel the legislature to appropriate funds, but also if eligibility must be expanded absent any funding.
It’s important Missourians take notice of how this situation plays out over the next few months because it could significantly impact the future of our state. Potential judicial action could affect the state’s initiative petition process, the health coverage status for thousands of Missourians, and the allocation of billions in future state revenue.
