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Missouri lawmakers OK $35B budget without Medicaid expansion

Posted at 3:22 PM, May 07, 2021

JEFFERSON CITY, Mo. — Missouri lawmakers approved a $35 billion budget on Friday that includes no funding for a Medicaid expansion approved by voters, putting Gov. Mike Parson's administration in a position to decide what to do next about the health care program for low-income residents.

The fiscal 2022 spending plan passed by the House and Senate includes funding increases for public schools, universities, hospitals and nursing homes, as well as a pay raise for state employees. It passed just hours ahead of a constitutional deadline.

Although Republicans noted that the budget increases funding for the current Medicaid program, they made clear that they didn't intend any of the money to be used to expand coverage for low-income adults under the terms of a constitutional amendment approved by voters last fall.

That measure says people ages 19-65 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.

Republican lawmakers believe that by not appropriating money for the expanded coverage, they can prevent it from occurring. But Democrats contend that the state must cover the additional people anyway, even if it means there would be less money available for everyone else in the program.

It will be up to Parson's administration to decide how to implement the budget, though any decision is likely to face a court challenge. Parson opposed the Medicaid expansion at the ballot box, but after voters approved it, he included funding for it in the budget he proposed to lawmakers earlier this year.

"We will assess our options and legal requirements on how to move forward regarding Medicaid expansion," Parson spokeswoman Kelli Jones said Friday.