Missouri Republicans block funds for voter-approved Medicaid expansion

Republican lawmakers blocked Medicaid expansion funding from reaching the Missouri House floor on Thursday, posing a setback for the voter-approved plan to increase eligibility for the state health care program.

The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million in state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.

The increased eligibility would allow an estimated 230,000 additional low-income Missourians to be covered. It is set to go into effect in July, after voters approved a ballot question last August with a 53% majority.

Democrats slammed the vote as an attempt to subvert Missourians’ wishes to implement the expansion, which several Republicans said was unpopular in their own districts.

Democrats plan to re-introduce the funds into the rest of the state budget on the House floor. Budget Chair Cody Smith, a Carthage Republican, said he will introduce another bill to spend the money elsewhere.

Ranking member Rep. Peter Merideth, a St. Louis Democrat, has warned that the move to reject expansion would leave the entire Missouri Medicaid program, known as MO HealthNet, underfunded when thousands more become eligible. Not going forward with the expansion, which is now part of the state constitution, could land the state in court.

Republicans, citing the cost, have long resisted expanding Medicaid in Missouri, one of about a dozen states that haven’t extended eligibility for the health plan.

In Kansas, Democratic Gov. Laura Kelly has called for an expansion and proposed to pay for it with revenue from the legalization of medical marijuana. But the idea appears dead on arrival in the Republican-controlled legislature.

Missouri’s Medicaid program does not currently cover most adults without children. Only the disabled, children and parents with incomes under 18% of federal poverty level — less than $5,800 a year for a family of four — are eligible. It is one of the lowest eligibility thresholds in the nation. The expansion will allow adults earning up to 138% of the federal poverty level to be covered.

In Missouri, Gov. Mike Parson opposed the expansion but said he would move forward with implementation after passage of the ballot question last year.

But Smith signaled his plan to oppose funding it earlier this year when he took the unusual step of separating the money from Parson’s proposed $34 billion state budget.

Nine Democrats voted for the bill and 20 Republicans, including Smith, voted against. Missouri Secretary of State Jay Ashcroft wrote on Twitter after the vote to commend Smith and committee vice chair Dirk Deaton, a Noel Republican, for their “commitment to fiscal responsibility.”

Expansion opponents said the state can’t afford to take on the cost. Deaton said the budget bills present “binary choices” between Medicaid expansion and social services for blind and disabled Missourians.

“It is to give free health care, government health care to able-bodied adults who can do for themselves,” Deaton said.

Smith has also cut $245 million of general revenue spending from Parson’s proposed budget, including some money for new mental health centers.

Democrats slammed that characterization, pointing out that state revenues are higher than expected and the state will get more than $1.1 billion from the federal government specifically for Medicaid expansion through the latest coronavirus relief bill, in addition to the $2.8 billion in other federal aid.

“I am flabbergasted by the narrative that we have to rob Peter to pay Paul here,” said Kansas City Rep. Maggie Nurrenbern. “If this committee votes this down ... I am unbelievably disappointed because you have forsaken your duty as a state representative.”

Proponents of expansion have said the influx of federal dollars would be an economic boon to rural hospitals and the health care sector.

Rural Republicans pushed back on Democrats’ arguments that voters had approved an expansion, saying voters could not require the state to spend money. Last year, a state appeals court judge found the expansion initiative did not have language directing the General Assembly to spend money, allowing it to be placed on the ballot.

Moberly Rep. Ed Lewis said despite that 53% of those who cast ballots in favor of expansion, the number did not amount to a majority of Missouri’s eligible voters or population.

“Rural Missouri said no,” said Rep. Sara Walsh, of Ashland. “I don’t believe it is the will of the people to bankrupt our state.”

While urban areas dominated in support for the expansion, it would not have passed without the one in three rural voters who supported the measure.

Across the capitol this week, a conservative effort to block Medicaid from paying for certain contraceptives also has stalled approval of annual funding for the program.

Late Tuesday night, Sen. Paul Wieland, an Imperial Republican, amended a routine hospital tax bill that helps pay for Medicaid by inserting a provision that prohibits the program from covering “Any drug or device approved by the federal Food and Drug Administration that may cause the destruction of, or prevent the implantation of, an unborn child.” Some oral or implanted contraceptives could fit that description.

Missouri law already prohibits Medicaid coverage of abortion except in cases where the mother’s life is at risk.

Twenty one Republicans supported the provision. Bill sponsor Sen. Dan Hegeman, a Cosby Republican, immediately tabled the bill.

Federal regulations require all insurance to cover contraceptives, with religious exemptions. A separate rule requires Medicaid programs to cover family planning services but does not explicitly spell out contraceptives.

It remained unclear Thursday whether the bill put Missouri’s federal Medicaid funding in peril, but Democrats pointed out the Medicaid expansion provision in the state constitution requires the program to cover the same services.

Majority Leader Caleb Rowden, a Columbia Republican who supported the contraceptive prohibition, said at a press conference that senators had spoken with the state’s Medicaid program officials and were “getting a couple of legal opinions.”

“We’ll make sure we don’t put the [funding bill] in jeopardy, I can say that,” Rowden said.

This story was originally published March 25, 2021 at 3:29 PM.