Lawyers make cases in suit over Missouri Medicaid expansion

JEFFERSON CITY, Mo. -- If Missouri conservatives don't want to fund a voter-approved expansion of the state's Medicaid program, they can either propose another constitutional amendment gutting it or cut funding to the existing program completely, a lawyer for three would-be new recipients told a judge on Monday.

If lawmakers set aside any money for the Medicaid program -- which they did -- then they must fund the expansion so that newly eligible adults get coverage on July 1, when the constitutional amendment kicks in, lawyer Chuck Hatfield told Cole County Circuit Court Presiding Judge Jon Beetem.

At issue is Republican Gov. Mike Parson's decision not to provide coverage for an estimated 275,000 newly eligible low-income adults after the GOP-led Legislature refused to provide any extra funding to do so in the state budget.

Three low-income women, including two mothers, sued the state in response.

Solicitor General John Sauer, who is defending the governor's decision not to expand Medicaid, told Beetem it's clear lawmakers intentionally left out of their budget any new funding for Medicaid expansion. Without that, Sauer said Parson's administration doesn't have the authority to implement the expansion.

"Funding and eligibility are not the same thing," he said. "In other words, to get Medicaid services there's really two logical steps: You have to be eligible under the law, and then the Legislature has to give the money to pay for the services."

Beetem said he would rule within days, although an appeal is expected regardless of his decision.

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.

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