Did Missouri Expand Medicaid to Low-Income Residents?

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Missouri must expand Medicaid to low-income residents, the state Supreme Court ruled unanimously on Thursday, finding that a state ballot initiative that voters approved last year was constitutional.

The Medicaid expansion in Missouri was to take effect on July 1. However, the roll-out was blocked by Republican Governor Mike Parson, who said in May that the state couldn’t move forward because lawmakers didn’t appropriate funding.

“The court has said the law is very clear, and that sends a very clear message to both the governor and the legislature that they need to get on with implementation,” said Chuck Hatfield, one of the attorneys who brought a lawsuit to enforce the expansion passed by voters in a recent ballot measure.

About 275,000 low-income Missourians could gain coverage under expansion, said CNN.com, in its recent article entitled “Missouri Supreme Court rules in favor of Medicaid expansion.”

However, the Missouri Supreme Court held that the appropriation bills don’t distinguish between benefits provided to those who qualified previously and those eligible under expansion.

“Clearly, the bills fund services to all who are eligible for MO HealthNet,” the court said in its opinion, referring to the state Medicaid program.

The Missouri Supreme Court judges agreed by a vote of 7-0 to send the case back to the lower court to enter a judgment for the plaintiffs. These are three Missourians with chronic health conditions who can’t afford coverage or treatment. The trial judge was also ordered to provide the implementation details. Enrollment could start by mid-August.

“After today’s court decision, the executive branch still lacks the necessary budget authority to implement MO HealthNet coverage to the expanded population,” the governor’s office said. “We are looking at what options may be available to us to seek additional budget authority and also pursuing legal clarity.”

Missouri became the sixth state to approve Medicaid expansion at the ballot box last year, when voters supported it by 53% to 47%. That vote was supposed to open the program to adults with incomes up to about $17,775 a year. Right now, childless adults in Missouri don’t qualify and the income limit for parents is 21% of the poverty level, or $4,600 a year for a family of three. This cut-off is one of the strictest in the nation. Even with the vote, Governor Parson refused.

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if passed,” the governor said at the time. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”

In the lawsuit, the plaintiffs argued that the state’s Medicaid program has been funded by the General Assembly, and lawmakers don’t need to set aside specific money for expansion enrollees. It also said that Congress’ $1.9 trillion COVID relief measure offers additional federal support to states that expand Medicaid, which would provide Missouri with more than $1 billion in extra money that would defray the state’s share of expansion for five years.

Here in Iowa, the state implemented full Medicaid expansion back in 2015. To manage the expanded system, Iowa has contracted with private insurance companies, called Managed Care Organizations (MCOs). There are currently two MCOs in Iowa: Amerigroup and Iowa Total Care.

In many cases, seniors applying for Medicaid are less concerned about their health insurance coverage and more focused on the long-term care benefit. However, the MCOs still manage the health insurance benefits for seniors on Medicaid – especially when a senior is receiving services through the Elderly Waiver program. We have lots more information on our blog about the benefits and risks associated with long-term care Medicaid. Check out our other posts here.

Reference: CNN.com (July 22, 2021) “Missouri Supreme Court rules in favor of Medicaid expansion”

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