A group of Missouri residents sued the state, alleging it must enroll them in Medicaid and cover their expenses because an approved ballot petition expanded eligibility and there is an appropriation from which services can be paid.
“This case, besides its implications for the Medicaid program, will provide additional clarity about what can be done by initiative,” said James Layton, civil appellate attorney emeritus for the Attorney General’s Office.
As previously reported, Missouri’s Medicaid plan was withdrawn on May 13 after the legislature failed to include $1.9 billion in the state budget to cover the cost.
“It's not a surprise that a lawsuit would be filed,” Layton told St. Louis Record. “It does present the question that's been debated politically, if not legally, for the last year and a half as to whether the constitutional amendment that enlarged the Medicaid program is valid and sufficient to actually accomplish that.”
Plaintiffs include Stephanie Doyle, Autumn Stultz, and Melinda Hille.
At issue is whether expansion by ballot initiative is constitutional.
“The constitution bars appropriation by initiative and there isn't much case law out there explaining what that means and so both sides will take advantage of that dearth of case law to make their arguments based on constitutional language and based on policy,” Layton said.
Some 275,000 people are eligible due to a ballot petition that was approved by voters, according to the Missouri Independent, and Medicaid expansion is set to happen nationwide on July 1.
"The governor and the director of the Department of Social Services have taken the position that they are not going to enroll the additional individuals in Medicaid who are qualified under the new provision,” said Layton, of counsel with Tueth Keeney law firm in St. Louis. “They also have withdrawn their application to the federal government for approval of an amendment to the state plan that would provide for that enlargement.”
He added that Republicans are standing in the way.
“The legislature that decided not to provide full funding for Medicaid is dominantly Republican," he said. "So, it's really a Republican decision not to provide the necessary funds and of course, the governor and his appointees are Republicans who have decided not to enroll those in the large population.”
A hearing is set for June 18.
“That means there is enough time for the court to rule before July 1 and I’m sure that is the intention of the plaintiffs is to have the court rule before July 1,” Layton said.
If the three plaintiffs win, Layton foresees the program running out of money and its appropriation at some point during the fiscal year.
“It's not unusual for there to be a supplemental appropriation for Medicaid in the spring anyway,” he said.