Missouri judge: Medicaid expansion unconstitutional

A Missouri judge on Wednesday ruled that a ballot measure to expand Medicaid is unconstitutional, meaning hundreds of thousands of newly eligible adults won’t be able to access the health insurance program July 1 as promised.

Cole County Circuit Court Judge Jon Beetem wrote that the voter-approved amendment unconstitutionally sought to force lawmakers to set aside money for the expansion.

Under the Constitution, lawmakers can’t be forced to make appropriations unless the ballot measure includes a funding mechanism.

Beetem wrote that the amendment “indirectly requires the appropriation of revenues not created by the initiative and is therefore unconstitutional.”

Voters approved Medicaid expansion last August, passing a constitutional amendment by 53% of the vote. It was set to take effect July 1.

But Republican Gov. Mike Parson declined 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 to try to force Parson’s administration to give them the health insurance coverage. The plaintiff’s lawyers said they will appeal Beetem’s decision.

Beetem’s ruling deals a major blow to supporters of Medicaid expansion. It all but guarantees that the thousands of newly eligible low-income adults under the amendment won’t have access to the program.

Lawyers for the plaintiffs in a statement wrote that a question over the amendment’s constitutionality wasn’t even raised before the judge during Monday’s trial.

“We are disappointed in today’s ruling, but believe the Court of Appeals will disagree,” the plaintiffs’ attorneys wrote in a statement.

Attorneys defending Parson’s administration declined to comment, citing an appeal.

During the trial, Solicitor General John Sauer had argued that additional funding approved by lawmakers was needed in order for Parson to enact the amendment.

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.