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Missouri governor scuttles Medicaid expansion after lawmakers provide no money

Missouri governor scuttles Medicaid expansion after lawmakers provide no money

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Gov. Mike Parson visits vaccination clinics in St. Louis metropolitan area

Gov. Mike Parson takes questions for the media after touring the vaccination clinic on Thursday, March 4, 2021, hosted by BJC HealthCare at Christian Hospital Northeast. Photo by Laurie Skrivan, lskrivan@post-dispatch.com

JEFFERSON CITY — Republican Gov. Mike Parson Thursday formally withdrew the state’s application to expand Medicaid to 275,000 low-income adults, citing the lack of funding provided by the GOP-controlled Legislature.

The move, which he expects to draw a lawsuit, came less than a week after the Legislature sent him a spending plan that stripped the $1.9 billion he had sought for the voter-approved expansion of Mo HealthNet.

The governor sided with lawmakers in saying the ballot initiative endorsed by voters in August 2020 didn’t provide a funding source to expand the government-funded health insurance program beginning on July 1.

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” Parson said. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our state plan amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”

In comments to reporters in the Capitol, Parson said the next step will be a legal fight.

“I’m sure it will end up in the courts,” Parson said. “I don’t even want to speculate what the courts will do because I think there are a lot of moving parts to this.”

The move drew a swift rebuke from supporters of the expansion, which would apply to adults ages 18-64 who earn less than $18,000 per year.

“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,” said House Minority Leader Crystal Quade, D-Springfield. “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.”

Emily Kalmer, spokeswoman for the American Cancer Society Action Network, said cancer patients cannot wait for legal battles to access the coverage that Medicaid expansion would provide.

“Earlier this year, during his state of the state address, Governor Parson committed to upholding the will of Missouri voters by funding Medicaid expansion. The Legislature has ignored the governor’s budget recommendations and has failed to include specific funding for expansion,” Kalmer said.

Senate Minority Leader John Rizzo, D-Independence, said the state has enough money to pay for the expansion if Republicans would stop blocking it.

“This is the Governor caving to the new Authoritarian Republican Regime that doesn’t respect the outcome of elections,” Rizzo said.

In his rationale, Parson cited a state appeals court ruling from June 2020 that said the ballot initiative did not create a revenue source or direct the General Assembly to appropriate funds. The court noted that the General Assembly retained discretionary authority to fund or not fund MO HealthNet expansion if the ballot initiative passed.

After the expansion was approved by voters, the Missouri Department of Social Services began laying the groundwork for expansion with the federal government, sending in paperwork for the upcoming changes.

But, following last week’s approval of the state budget, which covers the fiscal year beginning July 1, the governor yanked the applications.

The maneuver came just days after it appeared the administration was moving forward with plans to expand.

In a proposed rule change filed with the Missouri Secretary of State’s office, the Department of Social Services called on a legislative oversight panel to allow qualified hospitals to begin enrolling adults in July.

Even that sign didn’t mute concerns from the Missouri Hospital Association, which pushed hard for expansion, that a legal fight would occur.

On Thursday, MHA spokesman Dave Dillon said, “It’s disappointing that we are where we are. Every indication through today was that the administration was preparing for the expansion.”

Lawmakers opposed to the Affordable Care Act, known as Obamacare, said the state cannot afford the long-term costs of the expansion, even though the state’s budget is currently brimming with emergency stimulus cash from the federal government.

That same money could help pay for the expanded adult population when it becomes eligible on July 1.

In comments to reporters last week, Senate Majority Leader Caleb Rowden, R-Columbia, said there may not be enough money in state coffers to pay for an entire fiscal year of expansion, but it won’t stop the expansion from moving forward.

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