Missouri Medicaid funding imperiled after Senate abruptly adjourns on chaotic final day

The Missouri Senate abruptly adjourned Friday afternoon in the final hours of the legislative session, killing an array of measures and imperiling a tax key to funding the state’s Medicaid program.

Senators voted to adjourn after Democrats held off legislative business for hours, angry over what they described as a betrayal by Republican leaders on a deal to renew a tax on medical providers that generates billions each year to power Medicaid.

The fight over the tax began in March over an attempt by the Senate’s Conservative Caucus to block Medicaid from covering certain birth control methods. The conflict had resurfaced over the last two months before coming to a head early Friday morning when Senate President Pro Tem Dave Schatz, a Sullivan Republican, voted in favor of the anti-abortion side.

The measure, if it includes the anti-abortion provisions, could put the state in violation of federal rules on contraceptive coverage and risk federal funding for the program.

The collapse of the final day of the session into stalemate and recrimination is expected to force Gov. Mike Parson to call a special session to renew the tax, which allows Missouri to collect $1.6 billion next year and receive an additional $3 billion in federal funds.

The gridlock came the day after Parson announced his administration won’t expand eligibility for Medicaid after voters approved it in August, citing the General Assembly’s refusal to fund it. But the lack of the provider tax, which will expire in September, would threaten the financial stability of the entire Medicaid program.

“To play games with this tax, it’s asinine,” said Nikki Strong, executive director of the Missouri Health Care Association which represents a majority of the state’s nursing homes.

The tax generates 40% of nursing homes’ Medicaid reimbursement payments.

The Senate’s adjournment also ends the possibility of passing a bill that would stop residents from having to return unemployment benefit overpayments, which had almost unanimous support in the House, and could block efforts to pass legislation shielding businesses from COVID-related lawsuits. The liability protections were Parson’s top request to lawmakers.

Senate leaders downplayed the dysfunction to reporters after the abrupt adjournment, touting several bills lawmakers sent to Parson’s desk this year that had long been controversial among Republicans, including a tax-credit funded school choice program, a statewide system to monitor opioid prescriptions and the first gas tax increase in more than two decades.

“The Senate is a unique place with 34 very, very unique personalities,” said Majority Leader Caleb Rowden, a Columbia Republican. “I think any notion that, because we didn’t do something that doesn’t have to be done until September 30, is somehow a failure, I think is a misclassification.”

Rowden and Schatz had said throughout the past two months that the Senate would resolve differences on the anti-abortion measure pushed by Sen. Paul Wieland, an Imperial Republican, and pass the routine provider tax renewal.

Democrats were adamant that the renewal pass without additional language on abortion or birth control, but conservatives insisted on some version of its inclusion. Under state and federal law Medicaid already does not cover abortion.

After the House sent the Senate a version of the tax renewal without abortion-related language, Wieland moved early Friday morning for the Senate to reject it and include the coverage ban. Schatz’s vote in favor was the deciding one. With about 16 hours left in the legislative session, the move effectively killed the renewal.

Schatz told reporters after adjournment that he thought Wieland’s move would have succeeded without his vote.

“It’s a very difficult vote, to be in a position of voting against pro-life measures,” he said.

Late Friday morning when senators returned to the chamber, Democrats took the floor to share an update about Sen. Greg Razer, a Kansas City Democrat who briefly fainted overnight.

And then Minority Leader John Rizzo, an Independence Democrat, kept talking. He tore into Schatz for backtracking on what he said was a deal to get the tax renewed and said there was no need to try to pass any more legislation Friday after he was “continually backstabbed.”

“There’s fights that happen between the majority party and then leadership turns their guns on us,” he said. “The people that have been working with them to have a working, functional Senate.”

“I’m just done,” he added.

For hours, Democrats held the floor in a procedurally nebulous space, with some Republicans joining them to discuss their disappointments of the session.

Sen. Jason Bean, a Holcomb Republican, spoke with Sen. Steven Roberts, a St. Louis Democrat, about his bill to prevent private utility projects from using eminent domain, which would kill the Grain Belt Express transmission line. Bean had apparently expected Senate leaders to bring the bill up for floor debate, which did not happen.

Finally, just after 2 p.m., Rizzo moved to adjourn. The motion passed on a voice vote, with no audible “no” votes.

The House quickly reacted in anger, voting to temporarily send a bill on workers’ compensation back to committee, a way of punishing the Senate and eating up precious time before the 6 p.m. adjournment.

“Do not reward bad behavior,” Rep. Don Rone, a Portageville Republican, said in a speech that drew applause from some lawmakers.