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Missouri Judge Strikes Down Voter-Approved State Medicaid Expansion

The state's GOP-dominated Legislature refused to provide funding for the amendment that was passed with 53% of the vote last August.

JEFFERSON CITY, Mo. (CN) --- A state judge struck down voter-approved Medicaid expansion on Wednesday, finding the referendum was unconstitutional because it lacked a funding mechanism.

State voters approved the expansion, which would have made Medicaid available to an additional 275,000 low-income residents, in August 2020. The measure, which covers adults between the ages of 19 and 65 who were at or below 138% of the poverty level, passed with 53% of the vote.

However, the state’s Republican-dominated Legislature and Republican Gov. Mike Parson failed to provide funding for it.

Cole County Circuit Judge Jon Beetem made the decision in dismissing a lawsuit filed by three residents seeking a ruling stating that they should be able to enroll on July 1 despite the lack of funding.

“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,” Beetem wrote in a 6-page judgment. “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.”

The Medicaid expansion had an estimated cost of $1.8 million.

Plaintiffs’ attorney Chuck Hatfield, of Stinson LLP in Jefferson City, said in an email that he was disappointed in the ruling and that his clients will appeal.

“The trial Court's analysis here found that ‘Plaintiffs are absolutely right’ on the issues that were presented to the Court,” Hatfield said in a statement. “The Court then found that the initiative was not validly enacted because it used the initiative to appropriate. This is not an issue the State raised or argued at trial.”

Proponents of the bill, including the Missouri Hospital Association, say the expansion helps shield hospitals from increased costs of uncompensated care.

Opponents argue that the expansion should have included a funding mechanism on the ballot.

Beetem’s ruling comes two days after a hearing on the lawsuit, which was filed on May 20 --- a week after Parson announced he was scrapping the expansion after the Legislature failed to fund it.

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