Missouri Medicaid expansion's fate up to state Supreme Court

JEFFERSON CITY, Mo. -- Lawyers arguing over the implementation of Medicaid expansion on Tuesday told Missouri Supreme Court judges the voter-approved constitutional amendment should stand.

Judges are considering a circuit judge's decision last month to overturn the constitutional amendment to expand eligibility for the state's Medicaid program. Voters approved the amendment last year, but Republican Gov. Mike Parson refused to implement it after the GOP-led Legislature didn't provide any new funding.

Solicitor General John Sauer urged judges to let the amendment stand and interpret it as mandating eligibility expansion "but without requiring the Legislature to fund it, to preserve the Legislature's traditional authority" over the budget.

Chuck Hatfield, a lawyer for three newly eligible women who sued Parson for not implementing Medicaid expansion, called Sauer's argument "absurd."

"What that's arguing to do is to overturn an election," Hatfield said. "And that's pretty serious business that I don't think this court is going to engage in."

One judge questioned the Supreme Court's authority to invalidate the amendment.

"How is it that we can now look back at an election on an amendment that has passed and decide that it was invalid?" Judge Brent Powell said.

Hatfield has said lawmakers' only option to block Medicaid expansion is to defund the entire Medicaid program.

The Attorney General's Office in court documents urged Supreme Court judges to overturn a decision issued just last year forcing the state to pay Planned Parenthood as a way to justify lawmakers' ability to limit Medicaid funding to only some of those who are eligible.

In the 2020 decision, the Missouri Supreme Court ruled lawmakers overstepped their authority by using a budget bill to try to strip all government funding from Planned Parenthood. Judges said Missouri's Constitution prohibits lawmakers from using the budget to create policy.

Undoing that decision would clear the way for lawmakers to block Medicaid expansion without sacrificing the entire Medicaid program, the Attorney General's Office wrote in court filings.

Without that ruling, "Amendment 2 merely creates an eligibility category for Medicaid, and leaves the Legislature with unfettered discretion to fund or not fund services for the newly eligible category," lawyers for the office wrote. "This includes the authority to do what the Legislature did here -- appropriate funds for the pre-Expansion population, but not the Expansion population, while leaving the constitutional provision creating eligibility fully intact."

The Supreme Court did not indicate when judges might rule.