Judge Missouri: Expanding Unconstitutional Medicaid


A Missouri judge said Wednesday that a screening measure to expand Medicaid is unconstitutional, meaning hundreds of thousands of newly eligible adults will not be able to access the health insurance program on July 1 as promised.

Judge Jon Beetem of the Cole County Circuit Court wrote that the amendment approved by voters unconstitutionally sought to force lawmakers to set aside money for expansion.

Under the Constitution, legislators cannot be required to make appropriations unless the scrutiny measure includes a funding mechanism.

Beetem wrote that the amendment “indirectly imposes the appropriation of revenues not created by the initiative and is therefore unconstitutional.”

Voters approved the Medicaid expansion last August, passing a constitutional amendment by 53% of the vote. It went into effect on July 1st.

But Republican Gov. Mike Parson refused to provide coverage for an estimated 275,000 new low-income eligible adults after the GOP-led Legislature refused to provide additional funding to make it into the state budget.

Three low-income women, including two mothers, have been sued by the state for trying to force the Parson administration to give them health insurance coverage. The plaintiff’s lawyers said they would appeal Beetem’s decision.


Beetem’s decision gives a major blow to the supporters of the Medicaid expansion. All but guarantee that thousands of new adults eligible for low-income under the amendment will not have access to the program.

Lawyers for the plaintiffs in a statement wrote that a question about the constitutionality of the amendment was not even put before the judge during Monday’s trial.

“We are disappointed by today’s decision, but we believe the Court of Appeals will not agree,” the plaintiffs ’attorneys wrote in a statement.

Lawyers defending the Parson administration declined to comment, citing an appeal.

During the trial, Attorney General John Sauer had argued that additional funding approved by lawmakers was needed for Parson to enact the amendment.

The Missouri Medicaid program currently does not cover most adults without children, and its income eligibility threshold for parents is one of the lowest in the nation, at about one-fifth of the poverty level.

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