JEFFERSON CITY, Mo. (CN) — A trio of Missouri residents who sued the state after it refused to implement voter-approved Medicaid expansion argued their case before the Missouri Supreme Court on Tuesday in an attempt to overturn a state judge's dismissal of their lawsuit.
Their attorney Chuck Hatfield of Stinson LLP began the 30-minute hearing by noting the numerous times the public has had to go to the state’s high court for a ruling that the legislature has exceeded its authority. He also argued that the executive branch has the power to fund the expansion through appropriation.
“Here, we ask this court to remind the executive branch that the people, by a vote to amend their constitution, have required the executive branch to enroll our clients in the MO Health Net program,” Hatfield told the court. “There doesn't seem to be any dispute that the constitution says they shall be enrolled there, there is no dispute that they're qualified to be enrolled.”
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 are at or below 138% of the poverty level, passed with 53% of the vote.
However, the state’s GOP-dominated Legislature and Republican Governor Mike Parson refused to provide funding for it, prompting the lawsuit claiming the residents should be able to enroll on July 1 despite the lack of funding.
Cole County Circuit Judge Jon Beetem struck down the voter-approved Medicaid expansion on June 23, finding the referendum was unconstitutional because it lacked a funding mechanism. The case was immediately appealed to the state’s high court.
On Tuesday, the judges on the court asked Missouri State Solicitor General John Sauer how it could look back at an amendment that was passed and decide it was invalidly passed.
Sauer replied that existing precedent held that it was better to bring these types of challenges “in the context of actual rather than hypothetical … that logically implies that it can be done.”
Central to the case is the interpretation and implementation of Article III, section 51 of the Missouri Constitution, which states that the people, by initiative, may only spend or appropriate the revenues that they raise in the initiative.
Sauer told the court that there was no ambiguity in the Medicaid appropriations bills approved by the legislature that the funding was provided for preexisting Medicaid recipients only. He accused the plaintiffs in the case of "turning legislative intent on its head."
Hatfield concluded his rebuttal by stating there is a confusion between an appropriation and expenditure in this case. He argued the measure could be funded through an expenditure and urged the judges to overturn the lower court's dismissal.
“The people also reserve the right to amend their constitution and their laws through the initiative petition,” Hatfield said. “And because of that this court has consistently held that every doubt, and every ambiguity should be resolved in favor of upholding the will of the people.”
There is no timetable for a decision.
The Medicaid expansion had an estimated cost of $1.8 million.
Proponents of the bill, including the Missouri Hospital Association, say the expansion helps shield hospitals from increased costs of uncompensated care. Opponents, meanwhile, argue the expansion should have included a funding mechanism on the ballot.
The lawsuit 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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