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Missouri Supreme Court hears arguments in Medicaid expansion appeal

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KC Medicaid expansion rally
Posted at 11:55 AM, Jul 13, 2021
and last updated 2021-07-13 18:11:14-04

JEFFERSON CITY, Mo. — The Missouri Supreme Court heard an appeal Tuesday of a Cole County judge’s ruling that Missouri Gov. Mike Parson was legally allowed to block the enrollment of roughly 275,000 residents in MO HealthNet.

Voters passed Amendment 2 in August 2020, which created Article 4, Section 36(c) of the Missouri Constitution to expand Medicaid in the state.

Cole County Circuit Judge Jon Beetem ruled on June 23 that Parson’s refusal to expand Medicaid after the legislature didn’t appropriate money for new enrollees was lawful.

Attorneys for the plaintiffs — including Stephanie Doyle, Luke Barber and Christine Chaneyfiled an appeal June 24 to the Missouri Supreme Court.

RELATED | In-depth: Courts now must resolve Missouri’s Medicaid expansion fight

During the 34-minute hearing, attorney Chuck Hatfield, who represents several Missouri residents who sued for the right to enroll under Amendment 2, argued that this case is about how the government is supposed to work at its heart.

“The legislature doesn’t always like what the people instruct them to do,” Hatfield said.

He highlighted a 2010 bill regarding puppy mills and Clean Missouri, which the legislature worked to undermine and overturn after it passed in 2018.

In this case, Hatfield argued, “the people have required the executive branch to enroll our clients in MO HealthNet” and asked the Missouri Supreme Court to toss out Beetem’s ruling.

Hatfield argued that this year's spending bill does not have any wording that restricts his clients from coverage, and said the state is trying to add such language retroactively.

"What that's starting to do is to overturn an election, and that's pretty serious business that I don't think this court is going to engage in," Hatfield said after the hearing.

D. John Sauer, who argued the state’s case on behalf of the Missouri Attorney General’s Office, argued that Amendment 2 should be invalidated based on Article III, Section 51 of the Missouri Constitution, which states that initiative position “shall not be used for the appropriation of money other than of new revenues created and provided for thereby.”

"Their intent was not to fund the expansion population, but only to fund the pre-expansion population," Sauer said about the legislature. "The context matters."

Essentially, the state’s position is that Amendment 2 is constitutionally invalid because it didn’t explicitly spell out details of funding for Medicaid expansion.

Sauer argued that the legislature was not obligated to fund it and, absent of funding, Parson was within his rights to block the enrollment of people made eligible under Amendment 2.

Sauer highlighted the fact that it would cost an estimated $1.8 million in information technology costs for new computers and databases to enroll the roughly 275,000 newly eligible Medicaid recipients.

Missouri’s share would be roughly $400,000 with the balance coming from federal funds, but the legislature declined to appropriate any money for any aspect of the expansion.

“There’s no mystery of what the legislature was doing there,” Sauer said.

Medicaid has been a hot-button issue since voters passed Amendment 2 despite heavy opposition from Missouri Republicans and Parson.

The Missouri legislature recently passed a three-year extension of the federal reimbursement allowance, or FRA, which is the primary funding mechanism for the state’s Medicaid program, MO HealthNet, in a special session after Parson threatened massive budget cuts if it wasn’t renewed.