Judge to rule on Missouri Medicaid expansion lawsuit this week • Missouri Independent


The Cole County Courthouse in Jefferson City. (Photo by Tessa Weinberg / Missouri Independent)

A decision on whether Missouri should provide Medicaid coverage working-age adults will come in “a day or two,” Cole County Circuit Judge Jon Beetem said Monday at the end of a trial that will help decide whether 275,000 Missourians will become eligible for benefits. health care.

“I am sensitive to the time,” Beetem said, referring to the July 1 start date for benefits mandated by an initiative adopted by voters in August 2020.

During the hearing which lasted just over an hour, lawyer Chuck Hatfield tried to convince Beetem that the budget for the coming fiscal year makes no distinction between the various eligibility criteria when funding. services provided by Medicaid. That means the state must provide coverage if it continues to run a Medicaid program, Hatfield said.

“If you’re going to fund Medicaid, that now includes the population specified in the constitution,” Hatfield said.

John Sauer, representing the state on behalf of Attorney General Eric Schmitt’s office, told Beetem that nothing in the appropriation bills for the coming year instructs the state to authorize the benefits, and the legislative history of their enactment shows that the legislators decided not to open the rolls.

If lawmakers had intended to fund the expansion of Medicaid, Sauer told Beetem, it would be clear in the spending bills.

“It’s a huge deal,” Sauer said. “It is a political decision of enormous importance.”

Under Amendment 2, adults aged 19 to 64 would become eligible for Medicaid if their household income is 138 percent of the federal poverty guideline or less. That’s $ 17,774 a year for a single person, which works out to work about 33 hours a week at the state’s minimum wage of $ 10.30 an hour. For a household of four, the limit is $ 36,570, the income of one person working full time at $ 17.58 per hour, or two people working together 68 hours per week at minimum wage.

Under the current Medicaid system, no adult without children is eligible unless they have a qualifying condition such as a disability. Adults with children are eligible if their household income is below about 16 percent of the federal poverty guideline.

Missouri taxpayers cover about 35 percent of the costs of the traditional Medicaid system. The expansion group would benefit from coverage under the Affordable Care Act, which requires states to pay only 10% of the cost.

Amendment 2 ordered the state to begin coverage on July 1 and take all necessary preliminary steps to provide benefits on that date. When lawmakers refused to appropriate the $ 1.9 billion, including $ 130 million in general revenue, wanted by Governor Mike Parson to pay for coverage, the state withdrew an amendment to the plan submitted earlier this year to federal regulators.

Hatfield and attorney Lowell Pearson represent three people who would have been eligible on July 1. They are asking Beetem to determine if their customers are eligible and to order the state to provide coverage during the inevitable call.

While the case is likely to eventually go to the Missouri Supreme Court, Hatfield said after the hearing that he expects the case to go to the Court of Appeals for western district.

As he sought to convince Beetem, Hatfield argued that it was enough for him to determine whether the legislature was funding Medicaid services in the coming year and the laws governing eligibility.

This, in the context of a Missouri Supreme Court ruling last year that lawmakers could not use appropriation bills to bar Planned Parenthood from providing medical services to Medicaid clients, will rule the case, Hatfield said.

“I don’t think the court has a lot of work to do to figure out what the law is,” Hatfield said.

The High Court ruling on family planning showed that the only legal credits are those that set an amount and a goal. Everything else has to be dealt with in legislation or a constitutional amendment, Hatfield said.

Sauer was trying to convince Beetem that lawmakers could change Medicaid eligibility through appropriation bills, Hatfield said.

“It is essentially the state’s argument that the appropriation bill has changed the constitution and denies our clients the eligibility that the constitution guarantees them.”

Sauer called Hatfield’s arguments “deceptively simple.”

A “reasonable person” who had a good knowledge of Medicaid and its funding can see that lawmakers have not approved the expansion, Sauer said. The credits are all based on traditional Medicaid match rates, he said.

Further, although setting the appropriations for Medicaid is never an exact process, the huge gap between the money allocated for the coming year and the cost of the program with the expansion group shows that lawmakers do not. had no intention of funding it, he said.

“There is no logical inconsistency,” Sauer said, “because funding and eligibility are not the same thing.”


Julio V. Miller

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