A coalition of 12 community health centers has filed an amicus brief in support of Medicaid expansion after plaintiffs requested emergency relief from the Missouri Supreme Court in response to a Cole County Circuit judge ruling against them.
“Missouri community health centers rely to a significant degree on federal grants but that is not their only funding source,” wrote Attorney James Layton in the July 2 amicus brief. “Their capacity to provide care for uninsured and underinsured populations is also dependent on adequate numbers of insured patients to guarantee sustainability and financial solvency of these organizations.”
Community health centers are also known as Federally Qualified Health Centers (FQHCs), which serve some 600,000 Missourians in more than 2.2 million medical encounters yearly.
“My clients serve whoever shows up on their doorstep,” Layton told the St. Louis Record. “They've been very supportive of the expansion, in part, because most of their uninsured patients could become insured. They would get Medicaid coverage, which would help these community health centers extend the services that they can provide with the federal grants that they get.”
While the three plaintiffs in Stephanie Doyle, et al. v. Jennifer Tidball, et al allege in their lawsuit that the state must enroll them in Medicaid and cover their expenses because an approved ballot petition from 2020 expanded eligibility, opponents are leery that it will require much more money than the federal matching Medicaid payment rate of 5% that the American Rescue Plan is offering on a term basis for holdout states, such as Missouri
“This is not something that has a clear precedent that we can look to,” Layton said. “I don't know what the chances of success are.”
The Missouri Supreme Court is scheduled to hear oral arguments at 11 a.m. on Tuesday, July 13.
As previously reported in the St. Louis Record, Judge Jon E. Beetem ruled on June 23 that a ballot initiative to approve Medicaid expansion is unconstitutional because the Missouri Constitution requires an appropriation of state revenues.
“The question here is when you redefine the scope of an existing program but you still leave it to the legislature to decide to what degree to fund it, is that an appropriation by initiative,” said Layton, a former civil appellate attorney for the Attorney General’s office.
The ballot initiative in question is Missouri Amendment 2, also known as the Medicaid Expansion Initiative, which voters approved on Aug. 4, 2020, according to Ballotpedia. Some 676,687 voted in favor and 593,491 voted against.
“Many will qualify for Medicaid coverage if the expansion is made effective and, as long as it's not made effective, then they don't have any health coverage along with all the other uninsured folks in the state,” Layton said.
Layton further argues in his amicus brief that an appropriations bill must be taken on its face.
“The Court should reject the concept that legislative history, in whatever form, can replace the language of an appropriations bill,” he asserted in the pleading
The 12 community health centers Layton represents include Access Family Care, Affinia Healthcare, Care STL Health, Central Ozarks Medical Center, Community Treatment, Comprehensive Health Center, Family Care Health Centers, Great Mines Health Center, Katy Trail Community Health, KC Care Health Center, Missouri Highlands Health Care, Missouri Ozarks Community Health, and Samuel U. Rodgers Health Center.
“You don't get to construe the appropriations and say that the legislature didn't give enough money to fund it and so now you give Medicaid coverage to some people and not others,” Layton added.