A Missouri appeals court panel on Monday upheld the legality of a ballot initiative proposing to expand Medicaid health care coverage, though opponents vowed to continue their legal fight.

KANSAS CITY — A Missouri appeals court panel on Monday upheld the legality of a ballot initiative proposing to expand Medicaid health care coverage, though opponents vowed to continue their legal fight. 

The ruling by a three-judge panel of the Western District appellate court rejected assertions that the initiative forces the expenditure of state money in violation of the state constitution. It follows a similar ruling last week by a Cole County judge. 

Amendment 2 on the August ballot would expand eligibility for Missouri's Medicaid program to adults earning up to 138% of the federal poverty level, which is about $17,600 for an individual or $30,000 for a family of three. Missouri's program currently does not cover most adults without children, and it's income eligibility threshold for parents is one of the lowest in the nation at about one-fifth of the poverty level.

The ballot measure's financial estimate, prepared by Auditor Nicole Galloway, ranges from an annual cost of at least $200 million by 2026 to an annual savings of $1 billion. 

The initiative was challenged in court by conservative groups Americans for Prosperity-Missouri and United for Missouri. They contend it violates a constitutional provision prohibiting initiatives from appropriating money without providing a new revenue source. 

The appeals court said the initiative does not at face value require the appropriation of state money nor direct how much money the Legislature allots to Medicaid. 

Carl Bearden, the CEO of United for Missouri, said opponents would appeal the ruling again. The Missouri Supreme Court could take up the case or let the ruling stand.