Judge upholds Missouri lawmakers decision to not fund Medicaid expansion

(The Center Square) – Cole County Circuit Judge Jon Beetem Wednesday upheld the Missouri General Assembly’s decision not to fund Medicaid expansion. In the same ruling, Beetum also said an amendment voters approved to expand the taxpayer-funded health care program is unconstitutional.

In a six-page decision released mid-afternoon, Beetem said Missouri lawmakers and Gov. Mike Parson acted legally when they didn’t include money for voter-approved Medicaid expansion in the state’s $35 billion budget because the Missouri Constitution prohibits implementation of ballot measures without distinct funding sources.

“This Court concludes that Amendment 2 indirectly requires the appropriation of revenues not created by the initiative and is therefore unconstitutional,” Beetem wrote. “Accordingly, this Court declines to order the implementation of Medicaid Expansion.”

He said under the state’s constitution, a ruling that forces the state to fund the expansion would be a “court-ordered appropriation.”

Medicaid expansion proponents vowed to appeal.

“As all observers predicted, the issues around Medicaid expansion will be decided in the Court of Appeals. We are disappointed in today’s ruling, but believe the Court of Appeals will disagree,” attorney Chuck Hatfield and partner Lowell Pearson, who sued the state for “defunding “expansion, said in a statement.

“We will immediately appeal this decision to the Court of Appeals for the Western District of Missouri,” they said.

House Speaker Pro Tem John Wiemann, R-O’Fallon, said on Twitter that the ruling is a victory for Missouri taxpayers.

“Pushers of [expansion] erred when they deceived voters by failing to include a funding mechanism,” Wiemann wrote. “This unconstitutional initiative would have cost Missourians millions.”

Hartfield and Pearson filed the lawsuit May 20 on behalf of three women denied access to Medicaid services they would have been eligible for if expansion went into effect July 1.

Lawmakers approved, and Gov. Mike Parson signed, a $35 billion Fiscal Year 2022 budget without unding the expansion. The governor had originally requested a $130 million state match to draw $1.2 billion in federal dollars to provide 275,000 low-income Missouri adults Medicaid coverage.

During a 75-minute hearing Monday before Beetem in his 19th Judicial Circuit Courtroom in Jefferson City, Missouri Assistant Attorney General John Sauer argued expansion required lawmakers to “hide elephants in mouseholes” to pay for Medicaid expansion.

Sauer said lawmakers had discretion in funding Medicaid expansion, regardless of voters’ approval of Amendment 2, because the Missouri Constitution requires initiatives provide a corresponding revenue source. Amendment 2 doesn’t do that, he said.

Beetem’s ruling sustained that argument.

“Having fully considered the parties’ pleadings, evidence, and written and oral arguments, the Court concludes that the state’s refusal to enroll plaintiffs and other eligible individuals in the MO HealthNet program is not unlawful,” he wrote. “Notwithstanding a majority vote of the people, an initiative which does not comply with the limits of (the) constitution cannot stand.”

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