Legal Lens: Understanding Missouri’s Medicaid expansion controversy

Legal Lens

The Brown & Crouppen Legal Lens takes a closer look at everyday legal issues and gives you a better understanding of topics that may affect you.

ST. LOUIS – Medicaid expansion has been a huge topic of conversation in Missouri, but what would expanding the public health insurance program mean from a legal standpoint?

Andrea McNairy, managing attorney at Brown & Crouppen, says it’s a very hot-button issue.

“Medicaid expansion was passed this past 2020 election and it passed by a majority,” she said. “It expands Medicaid eligibility to cover the gap for people’s income, which is too high for state Medicaid but too low to make them eligible for the Affordable Care Act premium subsidy.”

What’s happened to date from a legal standpoint?

“It was passed by ballot initiative in August 2020 but the state constitution does not allow ballot initiatives to appropriate money without covering the cost of the new initiative without additional revenue,” McNairy said.

“So last year, an appellate court judge ruled that the ballot initiative did not violate the Missouri Constitution because 90% of the expansion would be paid by the federal government, so it didn’t need to require setting aside money. In addition, we know the CARES Act will now cover Missouri’s portion for over five years.”

Could this become a Missouri Supreme Court issue?

“Recently, Governor (Mike) Parson decided not to fund it, stating no money was set aside for it,” McNairy said.

Would this be the state legislature’s responsibility? Or the governor’s?

“The legislature has to fund it in the budget, then that would be approved by the governor,” McNairy said. “Som there was another lawsuit last Wednesday. A judge blocked the expansion of Medicaid on the basis it is now unconstitutional because of lack of funding. And all parties say the next stop is the Missouri Supreme Court.”

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