Missouri Medicaid expansion won’t go forward without funding, Gov. Mike Parson says

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Missouri will deny Medicaid coverage to an estimated 275,000 low-income residents who become eligible for the program July 1, Gov. Mike Parson announced Thursday.

Though 53% of Missouri voters approved a 2020 ballot measure to put expanded eligibility for the state health care program into the constitution, Parson said he can’t move forward without funding. The Department of Social Services on Thursday notified the federal government it was dropping the expansion.

The decision places the state squarely in the path of a lawsuit brought by expansion supporters, who hoped that even after the Republican supermajority in the legislature refused to put money in the budget for it, Parson might still allow the enrollment in July.

But the governor said the state’s Medicaid program, MO HealthNet, would run out of money if he does so.

“Without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time,” he said in a statement.

MO HealthNet has one of the nation’s strictest eligibility rules. It does not cover most non-disabled adults without children. Parents can qualify if their household income is no more 21% of the federal poverty level. In 2021, or less than $5,000 a year for a family of three.

Expansion would allow Missourians making up to 138% of the federal poverty level — or a little under $18,000 a year — to enroll.

Parson cited a state court of appeals decision last year in a case brought by expansion opponents challenging the Medicaid ballot language. Because only the General Assembly, not ballot initiatives, can authorize spending, they argued the measure should be removed from the ballot.

The court allowed it to remain because it did not come with language on how to pay for the expansion. Republicans have relied on that ruling for the past two months to argue the decision to expand still lies with them.

The expansion’s future will now almost certainly rest with the courts, which Parson acknowledged to reporters Thursday after the announcement.

“The same people that wanted it argued [in court] the fact that there wasn’t a funding mechanism to it,” he said. “So it’s just a problem. It’s going to have to be decided in a court.”

He said when the legislature refused the fund the expansion, “there weren’t a lot of choices left” for his office.

Democratic leaders excoriated Parson and the GOP.

“The Constitution says Medicaid Expansion happens on July 1. There is more than enough money in the budget to implement expansion. This is the Governor caving to the new Authoritarian Republican Regime that doesn’t respect the outcome of elections,” Senate Democratic Leader John Rizzo of Independence said in a statement. “This Governor is determined to block people’s healthcare while violating his oath to uphold Missouri’s Constitution.”

In a statement, House Minority Leader Crystal Quade, a Springfield Democrat, called the decision “dishonorable.”

“By backtracking on implementation of Medicaid expansion, Governor Parson is breaking his promise to the people of this state and violating his oath to uphold the Missouri Constitution,” she said. “Whatever reputation he once had for respecting the law is gone forever, and he is just another politician whose word can’t be trusted.”

In a letter to the federal Centers for Medicare and Medicaid Services withdrawing participation in the expansion, Parson wrote that the state “lacks the authority” to implement the section of the constitution governing the new eligibility. A CMS spokesman confirmed it’s aware of Missouri’s decision.

Parson had been opposed to the expansion but agreed to implement the will of the voters this year, asking for $130 million in state funds to pay for it. That would come with $1.6 billion from the federal government for the bulk of the expansion costs. Under the Affordable Care Act, the federal government picks up 90% of the tab.

The administration had been setting up the program to receive new applicants. The Department of Social Services sent the required documents to the federal government in February, and began writing department rules last month for the expansion.

U.S. Rep. Emanuel Cleaver, a Democrat who represents Kansas City, tied state legislators’ refusal to fund the program to a wider rejection of democracy by Republicans in the wake of the 2020 presidential election.

“When this issue is inevitably litigated in court, I hope — and expect — the courts will force the Governor and State legislature to follow the rule of law,” Cleaver said in a statement Thursday.

“Democracy is in danger in America. Whether it is Congressional Republicans lying about the fair and legitimate election of President Biden, leading to the worst attack on our nation’s Capitol in history, or state legislators rejecting a fair and legitimate ballot initiative approved by Missouri voters, these actions only further deteriorate our democratic institutions.”

The Star’s Bryan Lowry contributed reporting.

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