The state’s highest court decided unanimously last week to reverse and remand a Cole County Judge’s decision that Medicaid expansion is unconstitutional.
“It indicates to me that we were on very firm legal footing, this is not partisan and no matter where the Missouri Supreme Court judges were on the political spectrum, they saw that the law was solid and it favored plaintiffs in this case,” said Joel Ferber, a lawyer with Legal Services of Eastern Missouri who was among the lawyers who represented the plaintiffs.
“It's always really nice to have a unanimous decision. That was a really good result.”
As previously reported in the St. Louis Record, the plaintiffs in Stephanie Doyle, et al. v. Jennifer Tidball, et al appealed to the Missouri Supreme Court after Cole County Judge Jon E. Beetem ruled June 23 that a ballot initiative to approve Medicaid expansion is unconstitutional because the state constitution requires an appropriation of state revenues.
“It affirmed there is a constitutional right to Medicaid coverage and that the amendment was validly enacted and the court forcefully said the state may not discriminate among eligibility groups in its Medicaid programs,” Ferber told the St. Louis Record.
The Missouri Supreme Court made three key determinations that included the following rulings.
The ballot initiative does not violate Article 3 Section 51 prohibitions against appropriation by initiative.
“That means that there's a pretty high bar to invalidate an amendment adopted by the will of the people,” Ferber said. “I think it basically says the test is whether there is legislative discretion under the initiative and, if so, the initiative is valid.”
The ballot initiative in question is Missouri Amendment 2, also known as the Medicaid Expansion Initiative, which voters approved on Aug. 4, 2020. Some 676,687 voted in favor and 593,491 voted against.
House bills 10 and 11 do not contain a limitation against using the funds appropriated to provide coverage or services to individuals eligible only are under Article 4.
Medicaid expansion happened nationwide on July 1, however Missouri’s Medicaid plan was withdrawn on May 13 after the legislature failed to include $1.9 billion in the state budget to cover expansion costs.
“There's a lot of discretion that the court didn't get into but, in terms of services they cover, provider rates and cost-sharing, if you're going to have a program, they have got to cover this group and if they want to change who is covered, they have to either amend state statute or, in this case, amend the constitution. It’s a matter of law.”
The Missouri Independent estimates that 275,000 Missouri residents are eligible statewide.
The court denied the appeal on the intervenor issue and affirmed the trial court's decision.
It was previously reported in June that Judge Beetem denied an intervenor motion by St. Louis plaintiffs, Luke Barber, 26, and Christine Chaney, 43, who asked to join the litigation.
“There's this concept of permissive intervention,” Ferber added. “The court could have allowed them to intervene but chose not to because it didn't really add anything to the case. My view is that the interests of the intervenors are in fact the same as the interests of the plaintiffs. They will benefit from this decision.”