‘No mechanism to move forward at this time;” Governor Parson on move to pull Medicaid expansion plan

Missouri

JEFFERSON CITY, Mo. — Missouri’s governor said Medicaid will not expand to thousands of Missourians this summer after the Missouri Department of Social Services withdrew its plan to expand Medicare and Medicaid.

Voters approved the measure on the August ballot to expand Medicaid to anyone making less than $18,000. Lawmakers chose not to fund it in Missouri’s budget, which is why Gov. Mike Parson said the state didn’t have a choice and he’s content that there will be lawsuits.

“There’s really no mechanism to move forward at this time,” Parson said in a one-on-one interview. “I’m satisfied that it will end up in the courts and the courts will not be deciding that.”

Under expansion, 275,000 thousand Missourians were expected to become eligible. Parson said the state formally withdrew the state’s application Thursday to expand Medicaid in July. 

“Once the legislators didn’t fund it, I don’t think there was a lot of choices left,” Parson said. “The legislators did what they thought was right, whether we agree with it or not, that’s how it’s set up. That’s how democracy is set up and they chose not to fund it.”

Expansion was expected to cost $1.9 billion with less than $130 million coming from the state. The governor originally requested lawmakers to fund expansion in his own budget proposal. 

“People are probably going to have a hard time understanding that and say, wait a minute, I voted for it and you said that you’d fund it and then all of a sudden you’re not going to fund it,” Parson said. “The bottom line is, part of the process is for the legislative body to fund it and they didn’t fund it.”

Since there wasn’t a plan to fund the ballot initiative and Missouri lawmakers declined to find a way to fund it in Missouri’s $35 billion budget, the state doesn’t have the authority to move ahead with expanding Medicaid at this time, Parson said. 

“You can’t start the program and just hope to run it for 30 days or 60 days and pull it all out, you can’t do that,” Parson said. 

He believes the decision will be up to the courts. 

“I don’t think there’ll be any question that it’s going to the courts,” Parson said. “I don’t know how many lawsuits will be filed; I don’t know what decisions they are going to make out of that.”

The Missouri Hospital Association said it was not prepared for the governor’s decision Thursday morning. 

“We assumed because of his statements and the actions prior, which have been in line with implementing the measure adopted by voters, that we wouldn’t see something like this,” MHA Communications Director Dave Dillon said. “It’s a shame, it’s disappointing that the governor made this decision.”

Dillon said ten rural hospitals have closed in the last decade and Medicaid expansion would have prevented adding more to that list. 

“Those costs will continue to be incurred which by the way, at the same time, hospitals will be paying a provider tax to support the existing Medicaid program so that it cost the state less,” Dillon said. “If they [patients] need care, we’re going to take care of them, the difference is we’re not going to get paid for it.”

Instead, Missourians who have health insurance could foot the bill. 

“I’m not claiming poverty for hospitals, but what I am claiming is that when we do not get paid for individuals who come and seek uncompensated care, there’s only a limited number of things we can do and one of those is to shift the cost to those who have health insurance,” Dillon said. “

Dillon said in 2019, hospitals in Missouri racked up a total of $1.5 billion in uncompensated care. In the fight for expansion, Dillon said MHA will help uphold the will of the voters. 

“These individuals, through no fault of their own, will once again not be able to access healthcare services and that’s a shame,” Dillon said. “It’s our hope that the court will resolve that challenge, but that could take some time.”

House Minority Leader Crystal Quade, D-Springfield, responded to the governor’s announcement by saying,

“By backtracking on implementation of Medicaid expansion, Governor Parson is breaking his promise to the people of this state and violating his oath to uphold the Missouri Constitution. Whatever reputation he once had for respecting the law is gone forever, and he is just another politician whose word can’t be trusted. Medicaid expansion will still happen as the constitution requires, but because of the governor’s dishonorable action, it will take a court order to do it.”

Parson said that if the courts decide the state needs to expand Medicaid and fund it, the state will follow the law. 

“I think this will be a lengthy time in the courts, trying to find a solution to this and I think there will be lots of arguments on both sides,” Parson said. “At this point, there’s just no way to fund it.”

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