Missouri’s Medicaid Expansion Is On Again

Gov. Mike Parson, a Republican, then said he was unable to implement it.

Groups supporting the Medicaid expansion turned to the courts for relief. A lower court ruled in the state’s favor, finding that the legislature was not required to appropriate funds for Medicaid expansion. But the ruling from the Missouri Supreme Court now reverses that decision.

The court said that the state Medicaid program was now bound by the ballot initiative “concerning which individuals are eligible to enroll,” regardless of any appropriation decisions made in the legislature.

The new ruling directs the lower court to work out the details of getting the new program underway, but it is unclear when exactly Missouri will begin enrolling patients. Kelli Jones, a spokeswoman for Governor Parson, said in an emailed statement that the governor did not think he had the “necessary budget authority” to implement the expansion, and was “looking at what options may be available.”

Because of its timing, Missouri’s participation in Medicaid expansion is actually likely to leave the state better off financially, at least for the next two years. That’s because new federal stimulus funds, available to states that expand Medicaid this year, will cover the state’s 10 percent share of the program — and then some.

The state will receive about $1 billion over two years in additional funds for expanding Medicaid, according to a Kaiser Family Foundation estimate. Last summer, before those funds existed, Missouri’s state auditor had estimated that the Medicaid expansion would cost the state a maximum of $200 million.

Missouri is the second state to receive the new stimulus funds from the American Rescue Program, after Oklahoma, which opened its Medicaid expansion on July 1 after it also passed a ballot initiative in 2020. Both states passed their ballot initiatives before those stimulus funds were created.

The Fairness Project, a national nonprofit that helped organize the Medicaid ballot initiative in Missouri and in other states, is now aiming to put the issue to a vote in South Dakota in 2022. Groups there are gathering signatures ahead of a September deadline.

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