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Missouri Supreme Court rules Medicaid expansion approved by voters in 2020 constitutional

Published: Jul. 22, 2021 at 1:48 PM CDT|Updated: Jul. 22, 2021 at 2:30 PM CDT
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The Missouri Supreme Court on Thursday vacated a lower court’s decision in the state’s Medicaid expansion case, agreeing that the voter-approved plan to offer Medicaid to more people should stand.

The unanimous decision sends the case back to Cole County Circuit Court. The state Supreme Court ruled that the 2020 ballot measure approving expansion of the government-operated health care plan did not violate the Missouri Constitution because it “does not appropriate money and does not remove the General Assembly’s discretion in appropriating money to MO HealthNet.”

The ruling came just nine days after the Supreme Court heard the case, and a month after a Cole County judge overturned the constitutional amendment that Republican Gov. Mike Parson had refused to implement after the GOP-led Legislature didn’t provide any funding.

The lawsuit was filed on behalf of three women who were newly eligible for Medicaid. Their attorney, Chuck Hatfield, told the Supreme Court last week that the actions by the state would essentially “overturn the election.”

But Solicitor General John Sauer had urged for the Supreme Court to let the amendment stand and “preserve the Legislature’s traditional authority” over the budget.

Messages left with Hatfield and the Missouri Attorney General’s office were not immediately returned.

Advocates for the expansion said they were relieved by the ruling.

“We look forward to seeing Medicaid expansion swiftly implemented by the State so that all eligible Missourians receive the access to healthcare they need,” read a statement from the group Healthcare for Missouri. “This is not a partisan issue or a political issue - it’s a people issue.”

Missouri’s Medicaid program currently does not cover most adults without children, and its income eligibility threshold for parents is one of the lowest in the nation, at about one-fifth of the poverty level. The expansion is expected to add Medicaid eligibility for up to 275,000 low-income Missourians.

Voters approved Medicaid expansion last August, passing a constitutional amendment by 53% of the vote.

Read below a summary of the justices’ decision:

Missouri citizens eligible to enroll for Medicaid coverage under a new constitutional amendment expanding the class of eligible participants appeal from a circuit court’s judgment finding the amendment never became effective because the initiative petition by which it was enacted was constitutionally invalid. In a unanimous per curiam decision that cannot be attributed to any one author, the Supreme Court of Missouri vacates the judgment and remands the cause. The initiative petition enacting Medicaid expansion did not violate the state constitution’s ban on appropriation by initiative petition in that the constitutional amendment does not appropriate money and does not remove the general assembly’s discretion in appropriating money to Missouri’s Medicaid Program.

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