Missouri Supreme Court unanimously rules $1.9 billion Medicaid expansion constitutional

(The Center Square) – The Missouri Supreme Court on Thursday unanimously ruled last year’s ballot initiative to expand Medicaid was constitutional, allowing 275,000 additional people to enroll for health care coverage.

“Unanimous is a cool way to win,” attorney Chuck Hatfield wrote on social media after the decision.

The Supreme Court sent the case back to Cole County Circuit Judge John Beetem, who will issue a new ruling based on the decision.

Republican legislative leaders were silent on social media on Thursday, except for Senator Bob Onder, R-St. Charles, who reposted a media report with the words, “#JudicialActivism #BlackRobedTyrants.”

Hatfield represented three women who met eligibility guidelines approved by 53% of voters last August. They were between ages 19 and 65 and earning up to 138% of the federal poverty level.

During the 2021 legislative session, the General Assembly didn’t include funding for the newly eligible population. Medicaid expansion was estimated to cost $1.9 billion with federal funding sources paying for 90%.

After the budget was passed without expansion funding, Gov. Mike Parson on May 13 directed MO HealthNet, the state’s current Medicaid program, to stop expansion planning with the federal government.

A week later, Hatfield filed a lawsuit. Beetem ruled in favor of MO HealthNet on June 23, stating the ballot initiative lacked a funding mechanism. However, Judge Beetem questioned the constitutionality of the amendment. He agreed with Hatfield’s argument that any appropriation for Medicaid should be available to all eligible, including the expanded class of those eligible.

Republican legislators praised Beetem’s ruling.

“Big win for the rule of law in Jefferson City courtroom,” Rep. John Wiemann, R-O’Fallon, posted on social media the day of the ruling. “Pushers of Medicaid Expansion erred when they deceived voters by failing to include a funding mechanism. This unconstitutional initiative would have cost Missourians millions.”

The constitutional question provided Hatfield an opportunity to skip the appeals court and go to the Supreme Court. Hatfield argued the case before Missouri’s highest court on July 13 and fielded only one question from judges during a 30-minute proceeding.

In the 14-page ruling, the justices wrote Medicaid Expansion was constitutional and clear.

“With no ambiguity, the amounts appropriated and other extrinsic evidence cannot be used to alter the plain language of the purpose stated – to fund MO HealthNet without distinguishing between benefits provided to individuals who are eligible as part of the pre-expansion population and those eligible only under article IV, section 36(c).”

Chris Nuelle, a spokesperson for the Missouri Attorney General’s office, declined to comment because the case is ongoing. House budget committee chairman Cody Smith, R-Carthage, told media outlets he was reviewing the case and had no comment. During media briefings the final weeks of the legislative session, Speaker Rob Vescovo, R-Arnold, referred to Smith to answer all questions on budget matters concerning Medicaid expansion.

The justices quoted Beetem’s description of the legislature using “semantic and legal gymnastics” for not funding the expansion.

Dan Hegeman, R-Cosby and Senate appropriations committee chairman, used the same words to describe the Supreme Court’s decision.

“The legal gymnastics employed by the court to get their desired political outcome sets a dangerous precedent and greatly diminishes the power of Missourians’ elected representatives,” Hegeman said in a statement.

Scores of Democrats, progressive organizations, businesses and health care organizations praised the ruling.

“The people of Missouri have spoken and so has the highest court in the state,” Jessica Page, executive director of Progress MO, said in a statement. “There was never a doubt in our minds that the Missouri Supreme Court would stand up for the state constitution.”

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