Wallingford says difficult choices ahead on Medicaid expansion

This story is updated.

State Rep. Wayne Wallingford, R-147, Cape Girardeau, is in a unique position to know how the state government budget works.

Wallingford, 75, is the chairman of the tax-policy House Ways and Means Committee and during his previous eight-year Senate term also headed the same panel in the upper chamber.

The veteran lawmaker's voice may be key as the General Assembly figures out how to fund Medicaid expansion, given the Missouri Supreme Court's July 22 decision confirming the constitutionality of Amendment 2, approved by Missouri voters in 2020.

Wallingford also formerly sat on the Senate Appropriations Committee.

"I'm very familiar with where we can try to find money and where we might have to cut," said Wallingford, whose input in upcoming decision making about funding -- adding possibly 275,000 additional Missourians to the Medicaid rolls -- may be also important given his educational background.

The Cape Girardeau resident holds a master's degree in health care administration from Central Michigan University.

"One thing I got tired of hearing from the Democrats is, 'We're ignoring the will of the people,' after we initially declined to fund Medicaid expansion," Wallingford said, a reference to the legislature's reluctance to authorize monies after Amendment 2 passed statewide with 53.3% of the vote.

"Only a third of the people voted [in August 2020]. This means only 17% of Missouri's population put this language into Missouri's constitution."

Locally, Cape Girardeau, Scott and Perry counties voted against Amendment 2 by larger margins than the state as a whole.

Cape Girardeau County said "no" to Medicaid expansion with 68% of the vote. The margin in Scott County was a bit higher with 68.2%. Perry County rejected the amendment with 72%.

On Aug. 10, Cole County Circuit Court Judge Jon Beetem ruled the Missouri Department of Social Services must allow newly eligible residents who qualify for benefits under Medicaid expansion to enroll. Furthermore, Beetem's ruling said expansion must take effect as soon as possible, effectively rejecting Missouri Solicitor General John Sauer's request of an additional two months to begin accepting newly eligible residents to Medicaid.

Finding the money

"I have to say, the visits I got from constituents in the rural counties [of Senate District 27] after the election asked me not to vote to fund it," Wallingford said, adding those visitors "observantly" foresaw the end game.

"They knew one of the few ways to fund [expansion] is to decrease the payments current Medicaid recipients are now getting."

Wallingford said Missouri's Medicaid program, called Missouri HealthNet, currently has 890,000 people on the rolls, or 15% of the state's population of nearly 6 million people.

"I have been told our [Medicaid] program is one of the nation's best and is very generous, so if we have to take money away [from current recipients] -- and I'm not saying we will -- it'll be a step backward."

Wallingford said Missouri's constitution requires a balanced budget. Deficit spending to fund Medicaid expansion therefore is out of the question.

"We have to find the money somehow," said Wallingford, suggesting the mid-September "veto override" session scheduled in Jefferson City is a likely time for the financing question to be settled.

Gov. Mike Parson told St. Louis Public Radio earlier this month he will not call a special legislative session to allocate additional funding for Medicaid expansion unless legislators have a plan in place.

"It's going to be interesting to decide where to cut because there won't be a tax increase," Wallingford said.

"Even if we wanted [an increase], we'd have to wait until next year to get it and we have to fund the program now in 2021."

Wallingford said education and mental health are also areas where cuts might be made -- a prospect he said he abhors: "I'm a big proponent of mental health, and we put additional money in the budget for it, and I was really glad to see it."

By the numbers

Under the provisions of Amendment 2, 19- to 64-year-old adults whose household incomes are 138% of the federal poverty guideline or less would qualify for benefits under Missouri's Medicaid program.

That ends up being $17,774 a year for a single person, or $36,570 for a family of four.

Under the Affordable Care Act, states pay 10% of the costs of newly eligible Medicaid participants, with the federal government matching the remaining 90%.

"There are additional costs people overlook," Wallingford said. "We're going to need 75 additional employees and computer software and upgrades to handle the additional [folks] now eligible for Medicaid."