JEFFERSON CITY, Mo. (CN) — A Missouri judge on Tuesday reversed his own prior decision against a group of residents who sought to enroll in the state Medicaid system, ruling state officials cannot deny or limit benefits to those who became eligible under a voter-approved expansion.
In a two-page order, Cole County Circuit Judge Jon Beteem instructed the Missouri Department of Social Services to lift any barriers to Medicaid enrollment that eligible people across the state might encounter.
The reversal was made to comply with the Missouri Supreme Court's ruling last month that a voter-approved expansion of MO HealthNet, the state's Medicaid program, did not violate the state constitution. In his earlier June decision, Beetem ruled that it did.
The Medicaid expansion was first approved by a popular referendum in August 2020 to amend the state constitution. This amendment would allow individuals whose income is between 100% and 138% of the federal poverty level - between $26,500 and $36,570 per year - to enroll in MO HealthNet. Previously, only those making below 22% of the federal poverty line - about $5,500 per year - were eligible for enrollment.
Despite the referendum passing with 53% of the vote, the GOP-dominated Legislature refused to appropriate funding for it. Governor Mike Parson, also a Republican, then refused to approve the expansion by claiming his hands were tied by the Legislature's decision.
Beetem, a Republican, ruled in June that the referendum was unconstitutional because it lacked a funding mechanism.
“The non-appropriation language in Article III, section 51 of the Missouri Constitution provides that the people, by initiative, may only spend or appropriate the revenues that they raise in the initiative,” he wrote at the time. “If the court allows them to spend other state revenues by initiative, such action would deprive the General Assembly of its constitutional right to appropriate revenues in all other non-initiative circumstances.”
After the residents appealed, the Missouri Supreme Court unanimously ruled in July that the expansion did not violate the state constitution.
"Because [the Medicaid expansion amendment] does not appropriate money and does not remove the General Assembly’s discretion in appropriating money to MO HealthNet, the circuit court erred in declaring [the amendment] constitutionally invalid," the high court's ruling states.
Beetem's forced reversal now clears the way for up to 275,000 Missourians aged between 19 and 65 to enroll for Medicaid coverage. The total cost of the expansion is estimated to cost the state about $1.9 billion, and now the state's General Assembly will have no choice but to find funding for it.
Several Democratic state senators issued statements on the ruling, praising the expansion of health care accessibility to many of the state's poorest residents.
"Ever since Missourians voted in support of Medicaid expansion in August of 2020, there have been numerous delays in implementing the will of the voters. I am thankful the courts have finally put an end to these efforts once and for all," said Senator Karla May, D-St. Louis. "With this ruling, it is clear that now is time for the state to act and start allowing eligible Missourians to access the health care guaranteed to them under the Missouri Constitution.”
Neither Parson's office nor the office of Republican state Senate Majority Leader Caleb Rowden returned a request for comment.
The ruling also came on an historic day, as Missouri celebrated its bicentennial anniversary on Tuesday. It was admitted to the Union on Aug. 10, 1821, as the 24th state. Its admission to the union as a slave state - the only slave state north of the 36th Parallel - is often cited as one of the causes of the Civil War.
While he was silent on the Medicaid ruling Tuesday, the governor had much to say about the anniversary.
"I feel like I'm close to the roots of Missourians every day... I love the people of this state and I love the values of this state," Parson said at public ceremony at the Missouri Capitol. "I think it's what makes us so special."
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