Missouri governor drops voter-approved Medicaid expansion

JEFFERSON CITY, Mo. — 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The Republican governor said his administration had withdrawn a request to expand coverage that had been submitted to the federal Centers for Medicare and Medicaid Services in compliance with a constitutional amendment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 in August.

He noted 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 as 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.

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 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 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 people ages 19 to 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 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 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 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 American Cancer Society’s Cancer Action Network.

The Legislature’s refusal to add money for the Medicaid expansion is not the first time 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.