Missouri Supreme Court Overturns Medicaid Expansion Decision


On Thursday, the Missouri Supreme Court overturned a lower court’s decision to expand the state’s Medicaid program, agreeing that a voter-approved plan to offer Medicaid to more people should remain in effect.

The unanimous decision directs the case back to the Cole County District Court. The state Supreme Court ruled that the 2020 ballot approving the expansion of the state health plan does not violate the Missouri Constitution because it “does not embezzle money or deprive the General Assembly of the right to allocate money for MO HealthNet.”

The decision came just nine days after the Supreme Court heard the case, and a month after a Cole County judge overturned a constitutional amendment that Republican Gov. Mike Parson refused to implement after the GOP legislature failed provided no funding.

The lawsuit was filed on behalf of three women who were recently eligible for Medicaid. Their lawyer, Chuck Hatfield, told the Supreme Court last week that government action would effectively “cancel the election.”

But Solicitor General John Sauer has called on the Supreme Court to uphold the amendment and “preserve the traditional Legislature’s authority” over the budget.


Messages left to Hatfield and the Missouri attorney general’s office were not immediately returned.

Expansion supporters said the court ruling softened them.

“We look forward to the government’s rapid expansion of Medicaid so that all eligible Missourians have access to the care they need,” the Healthcare for Missouri group said in a statement. “This is not a party or political issue – this is a people’s problem.”

Missouri’s Medicaid program does not currently cover most adults without children, and its parent income threshold is one of the lowest in the country, at about one-fifth of the poverty line. The expansion is expected to add Medicaid eligibility to 275,000 low-income Missouri residents.

Voters approved the expansion of Medicaid last August, passing a constitutional amendment with 53% of the vote.

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