A Cole County Circuit judge decided that a ballot initiative to approve Medicaid expansion is unconstitutional because it did not require the state to appropriate funds.
“The Missouri Constitution provides that state revenues may not be expanded without an appropriation,” wrote Judge Jon E. Beetem in his June 23 opinion. “The plaintiffs admit that a supplemental appropriation would be required to fully fund expansion and implicitly request such an appropriation when they ask this court to order that plaintiffs and similarly situated individuals shall be provided MO HealthNet benefits. The court lacks the authority to order such relief as a legal effect would be court-ordered appropriation.”
As previously reported in the St. Louis Record, three Missouri residents sued the state, alleging it must enroll them in Medicaid and cover their expenses because an approved ballot petition from 2020 expanded eligibility, and there is an appropriation from which services can be paid.
“The claim that has been made, not so much by the Attorney General in this case but politically, is that Medicaid expansion constituted an appropriation because it required the legislature to provide this additional funding for Medicaid,” said James Layton, civil appellate attorney emeritus for the Attorney General’s office.
Medicaid expansion happened nationwide on July 1 however Missouri’s Medicaid plan was withdrawn on May 13 after the legislature failed to include $1.9 billion in the state budget to cover the cost. The Missouri Independent estimates that 275,000 Missouri residents are eligible statewide.
“You can have an initiative that says ‘Here's a new program. You have to fund it, and here's the money to do it, such as a new tax,’” Layton told the St. Louis Record. “But you can't have one that says to the legislature, ‘Here’s a new program. You have to fund it and we aren't giving any money to do it.’”
The American Rescue Plan has increased the federal matching Medicaid payment rate by 5% on a term basis for the 12 holdout states, which include Missouri, according to media reports.
Opponents argue that despite the 5% hike, the program could still require state funding.
“People who have opposed Medicaid expansion have said that there's no promise that it isn't in the future going to take an awful lot of state money and they don't want to start down that road and not have the money or be willing to spend the money at some point in the future,” said Layton who is currently of counsel with Tueth Keeney Cooper Mohan & Jackstadt in St. Louis.
Judge Beetem clarified in his opinion that the Missouri Constitution provides that the people by initiative may only spend or appropriate the funds, the revenues that they raise in the initiative.
“If the court allows them to spend other state revenues by initiative, such action would deprive the General Assembly of its constitutional right to appropriate revenues in all other non-initiative circumstances,” Judge Beetem wrote.
The three plaintiffs in the original lawsuit, Stephanie Doyle, Autumn Stultz, and Melinda Hille, have filed an emergency appeal with the Missouri Supreme Court. Oral arguments are set for 11 a.m. on Tuesday, July 13.
“The Missouri Supreme Court could uphold Judge Beetem’s ultimate result without upholding his rationale because he actually rejected the rationale that was asserted by the state in the case, and then adopted this other rationale,” Layton added. “So, they could affirm him on the same grounds, they could affirm him on different grounds or they could reverse.”