Medicaid expansion funding not guaranteed as Missouri budget goes to Senate

The fate of a voter-approved expansion of Medicaid now lies with the Missouri Senate, where the Republican floor leader did not commit Thursday to funding the plan.

The House on Thursday sent the state’s budget, without money for the expansion of the state health care program to about 275,000 more low-income Missourians, to the upper chamber.

Most Democrats, who failed this week to add expansion funding to the budget, voted no on the spending plan after lengthy floor debate. Republicans who have long opposed expansion have said they’re not obligated to pay for it, despite a constitutional amendment extending the eligibility that passed a statewide vote with 53% approval last August.

House Minority Leader Crystal Quade, of Springfield, and Budget Committee ranking member Peter Merideth, of St. Louis, told reporters they are confident the Senate will re-insert the $130 million of state funds and $1.4 billion of federal money for the expansion into the budget. The money was requested by Gov. Mike Parson, who opposed the expansion but has said he would honor the vote and implement it.

Doing so would also allow the state to receive more than $1 billion more over the next two years under the latest Biden federal aid bill.

Support for funding the expansion is far from universal among Republican Senators.

“Crafting a balanced state budget is a lengthy process that requires considerable attention to detail,” Senate Majority Leader Caleb Rowden, a Columbia Republican, said in a statement. “I can’t speculate on where members will ultimately land, but bills that happen to pass through both legislative chambers, especially budget bills, almost always include compromises necessitated by differences of opinion.”

House Republicans had excluded the money from the budget, arguing that the program’s expansion would be too costly, despite healthy state revenues and an upcoming influx of federal aid. Aside from the omission of Medicaid expansion funds, the $34 billion budget they passed was $300 million lower than Parson’s request, and took out spending on other social services that the governor wanted.

At his weekly press conference Thursday afternoon, Parson stood by his calculation that the state can afford the expansion.

“We do have enough money to cover it,” he said. “We put that in the budget.”

But he said it was too soon to say whether the state would be in a tough legal spot if the budget does not include Medicaid expansion money when the new eligibility begins July.

“I don’t know what the Senate’s going to do,” he said. “It’ll be challenged, there’s no question about that. If it’s not funded there will be challenges to that.”

On the Senate floor Thursday, Senate Conservative Caucus members Denny Hoskins, of Warrensburg, and Paul Wieland, of Imperial, both said they sided with the House majority and opposed the funding.

“Their argument is, well the Constitution says we have to do this or we’re going to get sued,” Wieland said. “Well, our job is as legislators is to legislate and appropriate and it’s the court’s job to decide whether or not we’re within the bounds of the Constitution. So I always say, if they want to sue us, let them sue us.”

Senate Minority Leader John Rizzo, an Independence Democrat, in a statement it would take “eight reasonable Republicans” to join the chamber’s 10 Democrats to “save” the expansion funding.

He referred to an amendment Wieland tacked onto a different funding bill for the state’s traditional Medicaid program last week, which would prohibit the program from covering certain contraceptives. State law already prohibits Medicaid from paying for abortions unless doctors certify the mother’s life is at risk.

After a majority of Republicans approved the amendment, that bill was tabled as Senators consult with lawyers on whether violated federal rules and put the state’s federal Medicaid dollars at risk. The federal government requires all insurance to cover birth control, with religious exemptions, and all state Medicaid programs to cover “family planning.”

“If they’re willing to sabotage the Medicaid program we have, there’s no reason to think they’ll support its expansion for working families,” Rizzo said. “Missouri Republicans are playing a dangerous game with people’s healthcare and I hope voters are watching.”

This story was originally published April 1, 2021 at 3:25 PM.