Judge sets trial date for lawsuit over Missouri Medicaid expansion

Rudi Keller
Missouri Independent

The lawsuit seeking to force Missouri to expand Medicaid coverage under a voter-approved constitutional amendment will go to trial June 18 in Cole County.

On Wednesday morning, Circuit Judge Jon Beetem met in a conference call with Attorney General Eric Schmitt’s office and attorneys for the three people suing for coverage. In an online notation with the case, Beetem ordered a “hearing on Stipulated Facts.”

That means that there is no dispute about what is happening. Instead, it is a dispute about how the law should be applied.

“Both sides will make their case to the judge and the judge will issue a decision in due course,” Marianna Deal, spokeswoman for Schmitt’s office, wrote in email. “Beyond that, we aren’t going to comment further on pending litigation.”

The lawsuit filed May 20 seeks an order for the Department of Social Services to allow newly eligible Missourians to enroll and receive coverage starting July 1. The quick trial date means it is possible Beetem will rule before that date, said attorney Lowell Pearson, who is representing the plaintiffs along with Chuck Hatfield.

“Certainly, on the plaintiff’s side, we want to move the case forward,” Pearson said.

The initiative approved in August 2020 directed that Missourians ages 19 to 64 would become eligible for Medicaid coverage if their household income is below 138 percent of the federal poverty guideline, or $17,774 a year for a single person. For a household of four, the limit is $36,570.

Before passage of the initiative known as Amendment 2, Missouri was one of 14 states that had not yet expanded Medicaid under the Affordable Care Act. The law originally made expansion mandatory but the U.S. Supreme Court ruled in 2012 that penalty provisions that made Medicaid an all-or-nothing program were unenforceable.

Adults who have no other qualifying condition such as a disability are only eligible currently if they have children and income lower than about $4,800 a year for a family of four. 

Under the Affordable Care Act, often referred to as Obamacare, the state would pay 10 percent of the expense with the federal treasury underwriting the remainder.

In his January budget proposal, Gov. Mike Parson recommended adding $1.9 billion to the state budget to cover the cost of the approximately 275,000 people who would become eligible. That amount included about $130 million in state general revenue.

The budget delivered to Parson by lawmakers, however, did not include the spending. Opponents argued that the long-term cost was too much for the state to bear and that constitutional provisions in place when the initiative went before voters made the amendment void because it did not include a revenue source for the state’s share.

Pearson and Hatfield argued in their filing that the initiative did not violate any other constitutional provision because it did not direct that the state spend any specific amount on the expansion group or Medicaid as a whole.

“The General Assembly cannot predict with certainty the number of individuals who will enroll in MO HealthNet during the next fiscal year or the health needs that those individuals will have during the next fiscal year,” the lawsuit states.

The state can decide how much it is willing to spend and spread the amount over the entire population, they wrote. Or, they wrote, lawmakers could, as they do every year, add enough money through a supplemental appropriation bill to pay for all required services.

The decision Wednesday means that both sides will work on a document stating the facts of the case. Each side will also file briefs setting out their view of the laws and precedents that will determine the outcome, Pearson said.

There is unlikely to be any witness testimony in the trial, which is set to begin at 3 p.m. on a Friday afternoon, Pearson said.

“The lawyers will argue what that means and Judge Beetem will decide,” he said.

Pearson said he thinks a ruling by July 1 is likely.

“We did discuss the July 1 eligibility deadline and asked for a hearing as soon as possible,” Pearson said.

However Beetem rules, it is unlikely it will be the final word on the case. The losing side is almost certain to appeal.

If the state does not expand Medicaid coverage, it will give up a chance to receive about $1.2 billion in federal support for the traditional Medicaid program. The American Rescue Plan passed in March increases the federal share of the traditional program by 5 percent for states that expand Medicaid in the next two years.

Missouri Independent is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a public charity.