Enrollment for expanded Missouri Medicaid must begin with no further delay, judge rules

Low-income Missourians who are newly eligible for Medicaid under a constitutional amendment approved by voters last year can no longer be denied coverage, a Cole County judge ruled Tuesday.

Cole County Circuit Judge Jon Beetem ordered the state’s Department of Social Services not to block residents eligible for the program as of July 1, the date expansion was to begin. He also told officials not to impose additional burdens on them compared to existing Medicaid recipients.

That means signups for the state health program, known as MO HealthNet, can begin and the state must start accepting applications from about 275,000 of Missouri’s working poor.

Ruling in favor of three Missouri women who sued the state, Beetem brushed aside arguments from state officials that they needed two more months to set up computer systems, hire new staff and re-submit an expansion plan to the federal government before enrolling new Medicaid recipients.

Beetem heard arguments last Friday over how soon the expansion must begin. This followed a unanimous ruling by the Supreme Court last month that the state is obligated to follow the constitutional amendment approved by voters in 2020 and enroll those who are eligible.

The Supreme Court overturned an earlier ruling by Beetem that the amendment was invalidly enacted because only lawmakers can direct the state to spend money. The high court decided the ballot measure did not prevent the Republican-dominated legislature from budgeting as much or as little money as they wanted toward Medicaid, but said Parson’s administration was bound by the constitution’s eligibility rules.

The new eligibility laws allow those earning up to 138% of the federal poverty level — about $17,700 a year for a single person — to gain coverage. Previously, most adults without children did not qualify, and those with children had to earn less than 22% of the poverty level, or about $5,800 for someone in a family of four.

A spokeswoman for DSS could not immediately be reached for comment.

Lawyers for the three women who would qualify under expansion, acknowledged last week it will take DSS some time to process new applications and fully enroll all who are eligible.

But the state had to get started, attorney Chuck Hatfield said on Friday.

The expansion of Medicaid eligibility was approved a year ago by voters with a 53% statewide majority after nearly a decade of attempts by advocates in the General Assembly.

But the Republican-dominated state legislature refused to budget money for new enrollees, rejecting $130 million in state money and about $1.6 billion in federal funds. Parson nixed the expansion plan when he was presented a budget without the money.

With new enrollees, the state will run out of money for the Medicaid program before the fiscal year’s end next July. But expansion advocates have pointed out that lawmakers regularly add money to the budget midway through each year.