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State Supreme Court Rules Missouri Must Expand Medicaid - NPR

Campaign workers David Woodruff, left, and Jason White, right, deliver boxes of Medicaid expansion initiative signatures to the Missouri secretary of state's office in Jefferson City, Mo. on May 1, 2020. David A. Lieb/AP

David A. Lieb/AP

Thursday, the Missouri Supreme Court ruled that an additional 275,000 low-income individuals in the state are again eligible for publicly-funded health care.

Missouri voters successfully pushed through a state constitutional amendment on the ballot last August to adopt Medicaid expansion, but the Republican-dominated legislature refused to implement it, prompting Gov. Mike Parson, also a Republican, to pull the plug on plans to bolster the health care program.

(Thirty-eight states, including red ones, have either expanded Medicaid or are in the process of expanding it.)

The question before the Missouri justices was whether the 2020 ballot item required lawmakers to appropriate money, which would have been a violation of state law. In a unanimous opinion, the state Supreme Court ruled that was not the case — that new Medicaid recipients would join the existing pool of Medicaid recipients in the state and that lawmakers would have to decide what to do when the current appropriation runs out.

The decision does not mean newly eligible Missourians can access benefits immediately. In May, Gov. Mike Parson withdrew federal paperwork that set up the enrollment process. His office did not immediately respond to a request for comment.

Lowell Pearson, one of the attorneys for three women seeking to get access to Medicaid, said the ruling was a total victory for his clients. "On August 4 last year, the voters said 'we want these people to get Medicaid,' " Pearson said. "We're a major step closer to them getting it."

The amendment, which passed with 53% of the vote, makes adults between the ages of 19 and 65 eligible for Medicaid if they make 133% of the federal poverty level — or about $35,200 for a family of four. It also prohibits the state from enacting work requirements for Medicaid recipients. Currently, very few adults who have no dependents are eligible for Medicaid.

Amy Blouin, the president of the Missouri Budget Project, which supports expansion, said in a statement she hoped expansion would be implemented quickly.

"As a result of the Supreme Court's ruling, Missourians across the state will finally be able to realize the health and economic benefits of Medicaid expansion," she said.

"State after state has shown that in addition to providing insurance to those eligible, expansion is a fiscal and economic boon to state economies and budgets," Blouin said.

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