Missouri Medicaid expansion case puts voter-approved constitutional amendment on trial

·3 min read

More than a year ago, a Missouri appeals court allowed a constitutional amendment expanding Medicaid eligibility to be placed on the statewide ballot.

The three-judge panel of the Western District Court of Appeals last June rejected arguments by conservative groups seeking to strike the proposed amendment from the ballot, ruling that it was constitutionally sound because that it did not seek to appropriate funds.

Voters approved it last August with a 53% majority. It was expected to go into effect twelve days ago.

Yet it’s the Missouri Supreme Court that will now decide the future of state health coverage for 275,000 low-income Missourians — and whether the amendment was valid at all.

Judges heard oral arguments Tuesday in the lawsuit brought by expansion proponents against the state after Gov. Mike Parson scuttled the plan in May. He said he lacked the authority to move forward after the Republican-dominated legislature blocked funding.

It was a rare case of a Missouri court reviewing the legitimacy of a policy change after its approval in an election.

And it renewed questions from last year’s court case over whether the power to create costly government programs lies with voters or lawmakers.

“What that’s arguing to do is overturning an election,” Chuck Hatfield, attorney for the expansion advocates, told reporters after the hearing.

This year’s case originated in Cole County Circuit Court, where Judge Jon Beetem ruled last month that Parson’s administration had the right to deny coverage to the newly eligible.

In the circuit court, Hatfield represented three low-income Missouri women who would have qualified for Medicaid under the constitutional amendment. He and state Solicitor General Dean John Sauer sparred over whether the state had the obligation or authority to extend coverage to the newly eligible, without lawmakers approving extra funds specifically for that purpose.

Beetem ruled in favor of the state, but based his decision largely on an argument the state didn’t make. He said the amendment violated a section of the constitution which prohibits ballot initiatives from being used to authorize government spending. The amendment was never “validly enacted,” he wrote.

That ruling brought Hatfield and Sauer to the Supreme Court Tuesday, where the seven judges considered the validity of the constitutional amendment itself. They asked few questions during the half-hour hearing.

During the legislative session this year, lawmakers argued that because they alone have the power to appropriate money, the decision to expand still lay with them. They repeatedly rejected proposals to spend $130 million extra -- and $1.6 billion in federal funds -- on the Medicaid program for new enrollees.

Proponents have argued the state must enroll all who are eligible regardless of specific funding for the “expansion population.”

Sauer said Tuesday that the cost of new enrollees, and previous court rulings preventing legislators from dictating Medicaid eligibility policy in budget bills, makes the constitutional amendment effectively an appropriation of money. He challenged whether the ballot measure met the ”criteria for getting into the constitution in the first place.”

Judge W. Brent Powell questioned whether the court should have the power to decide that.

“Amendment 2 is passed,” he said. The amendment “is in the books. How is it that we can now look back at an election, on an amendment that is passed, and decide that it was invalidly passed?”

Sauer said it was easier to review the issue after the election and determine whether the ballot measure by “practical necessity” was requiring funding.

“You can do post-amendment challenges,” he said.

Parson’s decision to cancel the expansion plan has sparked fury from voters and advocates, who protested in Jefferson City this month on the day it was expected to go into effect.

If the court rules against the state, his administration will likely run out of money for the program with new enrollees included, and faces calling lawmakers back to the capitol for a second special session on Medicaid funding.

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