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With Medicaid expansion in limbo, Missouri House set to vote on budget

With Medicaid expansion in limbo, Missouri House set to vote on budget


Missouri House members argue on Tuesday, March 30, 2021, that their fellow representatives need to fully fund an expansion of Medicaid that voters approved in August 2020.

The Missouri House debated a plan to strip funding from the Medicaid expansion plan, which voters approved in August 2020. Here, Republican members explain some reasons to hold funding.

JEFFERSON CITY — Republicans in the Missouri House are poised to use $128 million that would have paid for a voter-approved expansion of Medicaid for other programs in the state budget.

The House is set to begin debate on the state’s $34.6 billion spending plan Tuesday, with an eye on sending the full blueprint to the Senate on Thursday.

Democrats on Monday vowed to push back against the plan to strip funding from the Medicaid expansion plan, which was included in Gov. Mike Parson’s budget proposal after voters approved the expansion in August 2020.

“The fight for expansion is over,” said House Minority Leader Crystal Quade, D-Springfield. “This fight is so unnecessary and little more than a destructive temper tantrum by petulant children who didn’t get their way.”

The GOP-led budget panel Thursday voted to reject expansion plans that were approved by 53% of voters. Approval of the ballot issue was supposed to bring Medicaid insurance to an estimated 275,000 additional Missourians, but Budget Committee Chairman Cody Smith said he’s worried it would provide publicly funded health care to able-bodied workers.

“By standing up to liberal special interest groups, House Republicans have saved Missourians over $100 million in general revenue in the upcoming fiscal year alone, and billions more in years to come,” said Smith, R-Carthage.

The Missouri Hospital Association, which pushed for the expansion, was disappointed by the action.

“We were not happy with what we saw,” MHA spokesman Dave Dillon said.

Despite the pandemic, the state budget is flush with cash heading into the next fiscal year on July 1. In addition, the state is receiving additional federal emergency stimulus money and will get additional money over the next two years if it expands the program, known in Missouri as Mo HealthNet.

“We have the money,” said Rep. Peter Merideth, D-St. Louis, who is the ranking Democrat on the budget panel. “We’re talking well over a billion dollars, maybe even $1.5 billion, that is in this budget that we’re not spending.”

Dillon, too, said affordability should not be a reason for ignoring last year’s vote.

“This is to likely cause a financial crisis,” Dillon said.

Smith filed legislation Friday that would put the money toward other state programs, including mental health treatment and the state’s underfunded public defender system.

He also steered $18 million toward school transportation, which is tied to a plan to provide tax credits to fund scholarships at private schools.

Smith also earmarked $30 million for a one-time increase for nursing homes.

Merideth rejected Smith’s decision to funnel money for Medicaid to other programs and services, saying the state has enough to fund them and the expansion.

“We are hearing this false narrative, this false choice that is pitting services for vulnerable Missourians on one side against Medicaid expansion on the other,” Merideth said.

If funding for Medicaid expansion runs out, lawmakers may have to return to the Capitol to provide more money. Barring that, expansion advocates could go to court to force the money to be provided.

“Whether Republicans like it or not, Medicaid expansion is happening,” Quade said. “They would rather cling to an extreme partisan dogma that holds our state back than accept the tremendous economic and health benefits that expansion will provide.”

The argument over Medicaid has overshadowed other elements of the budget, including fully funding the state’s school funding formula, cuts to Amtrak service and raises for state workers.

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