In August 2020, Missouri voters approved Amendment 2 to expand Medicaid in Missouri.
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. MHA will provide regular updates, news and resources as they become available.
MHA produced a working document, “Hospital Guidance for Promoting Enrollment and Reimbursement for Missouri Medicaid Expansion Adults,” to address Medicaid expansion enrollment strategies, reimbursement standards and answers to FAQs.
Last updated: Aug. 26, 2021
On July 22, the Missouri Supreme Court upheld the will of the voters and ensured access to health care for approximately 275,000 Missourians. The decision came after expedited litigation to compel state officials to implement Medicaid expansion. On May 13, citing a lack of budget authority from the General Assembly, the Department of Social Services withdrew the proposed State Plan Amendment previously submitted to the Centers for Medicare & Medicaid Services for expansion. Three individuals eligible for benefits under constitutional Amendment 2 filed suit.
After a hearing, the Cole County Circuit Court ruled Amendment 2 was unconstitutional because it lacked a funding source. Article III, § 51 of the Missouri Constitution states the initiative process may not be used to appropriate funds unless the measure supplies its own source of revenue. The court reasoned that Amendment 2, by practical necessity, requires additional funding to cover the expansion population and therefore violates Article III, § 51. Because the case was decided on constitutional grounds, it was appealed directly to the Supreme Court.
The Court unanimously ruled that Amendment 2 is constitutional under a plain text reading of the appropriations bills. As of July 1, the expansion population was entitled to benefits on the same terms as the pre-expansion population, and nothing in the enacted budget bills altered or restricted the former group’s entitlement to benefits.
Lawyers for the state argued that several contextual cues signaled the General Assembly’s intent to forego expansion funding. First, the appropriations bills contain no reference to the enhanced federal matching funds available under expansion. Second, the legislature considered and rejected numerous bills that would have expressly provided the estimated dollars necessary to fund expansion, including the governor’s recommended budget. However, the Court determined it need not consider legislative intent when the language of the appropriations bills was clear and unambiguous.
The Court remanded the case to the Cole County Circuit Court to issue an order in favor of the plaintiffs and providing appropriate relief. The parties expect the judgment to be issued on or shortly after Aug. 6, on which date the court has set aside time to hear any unresolved issues between the parties on the terms of the order. MHA staff anticipates enrollment will begin within the next few weeks thereafter, as the state likely will need time to activate the administrative systems necessary to manage the enrollment process.
Additional details and resources will be posted as they are available.
- Missouri Foundation for Health: Medicaid Expansion Message Guide – Multiple Languages
- Missouri Foundation for Health: Social Media Assets
- Missouri Foundation for Health: Message Guide to Clearly Communicate with Missourians about Medicaid expansion (8/11/21)
Reports & Fact Sheets
- MHA: Medicaid Expansion in Missouri Fact Sheet
- Regional Economic Models, Inc.: New Impact Report Shows Broad Economic Benefits to Medicaid Expansion in Missouri
- Health Management Associates: Medicaid Expansion in Missouri – Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana and Ohio Experiences | Executive Summary