No need for special session to fund Missouri Medicaid expansion: Lawmakers


Missouri is complying with a court order to enroll an anticipated 275,000 low-income residents into its Medicaid program under last August’s voter-approved Amendment 2.

State attorneys sought to delay enrollment until September because, among other reasons, Missouri lawmakers had not allocated the $130 million in state money to garner the $1.65 billion federal match to pay for it.

Last week, House Budget Committee Chair Rep. Cody Smith, R-Carthage, said the Medicaid program would run out of money in December – six months into the fiscal year – prompting calls for Gov. Mike Parson to call a special session.

But that likely won’t be necessary, at least not anytime soon, Republican and Democratic legislative leaders say.

Missouri’s $12 billion Medicaid budget should be sufficient to carry the program into January when the General Assembly convenes its 2022 session in January, concur Senate Appropriations Committee Chair Dan Hegeman, R-Cosby, Senate Minority Leader John Rizzo, D-Independence, and ranking House Budget Committee minority member Rep. Peter Merideth, D-St. Louis.

“I don’t know if there’s any need right now to do a special session,” Hegeman told reporters, noting he’d spoken with Smith and the Governor’s Office and there’s little momentum for calling lawmakers back to Springfield.

Rizzo and Merideth said the wait-and-see doesn’t mean there won’t be a special session before January, but that there’s no need to call one anytime soon.

“There’s ample amounts of money and ways to do it,” Rizzo said. “They have plenty of money to be able to do it. And they need to do it. And they need to do it now.”

Merideth said the Missouri Department of Health & Senior Services (DHSS) can direct federal pandemic assistance money to pay for any gaps in Medicaid funding created by the expansion.

“There’s no funding source we have to come up with. It’s all right there,” he said. “And it’s in fact required by the Constitution that we do that, because it says we have to maximize the federal dollars we can leverage.”

Last August, Missouri voters approved Amendment 2 by a 53% margin, expanding Medicaid under the Affordable Care Act.

But Missouri’s Republican-controlled Legislature adopted a $35 billion Fiscal Year 2022 budget that didn’t include the state match to draw federal dollars to pay for expanded coverage under Amendment 2.

Lawmakers contended that Amendment 2 was unconstitutional because Missouri law requires ballot measures that incur expenditures to identify a revenue source. Citing that argument, they refused to allocate state match money for expansion.

Attorneys representing three women who would have been eligible for Medicaid under Amendment 2 filed a lawsuit in May claiming the Legislature defunded Medicaid expansion “despite the clear directive from voters.”

Cole County Justice Jon Beetem on June 22 upheld the state’s argument, ruling the amendment could not be implemented without a funding source. But in a unanimous July 22 ruling, the state’s Supreme Court overturned Beetem’s decision and remanded the case back to him to “issue a judgment for the plaintiffs.”

State attorneys requested a delay of at least two months in implementing expansion but on Tuesday, Beetem ordered the state to immediately open enrollment.

Rep. Rasheen Aldridge, D-St. Louis, sent a letter to Parson on Tuesday urging him to convene a special session to appropriate supplemental Medicaid funding.

“We have a responsibility now to do what should have been done earlier this year during the budget process,” he wrote. “You hold the authority to ensure the General Assembly does not let this essential program go unfunded. I encourage you to use it.”

Last week, Parson told St. Louis Public Radio’s “Politically Speaking” he would not call a special session unless there’s a plan in place.

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