Medicaid expansion advocates sue Missouri, Parson administration to force coverage

Advocates for Medicaid expansion took Missouri Gov. Mike Parson’s administration to court Thursday over its refusal to extend eligibility for the health insurance program to an estimated 275,000 low-income residents under the terms of a constitutional amendment approved by voters last year.

Proponents have sued the state’s Department of Social Services on behalf of three Missouri women with chronic health conditions who would have qualified for coverage in July had Parson not nixed the expansion plan last week, after Republican lawmakers sent him a budget without funding for it.

They are asking a Cole County Circuit Court judge to order the state to enroll newly eligible Missourians in its Medicaid program, MO HealthNet, effective July 1. That would likely force Parson to call a special legislative session to add more money to the program.

GOP lawmakers opposed to expansion argue that because they control state spending, the decision to expand is in their hands.

Attorneys asserted that regardless of how much funding lawmakers approve, Parson’s administration must provide coverage to anyone eligible under the constitutional amendment voters passed last August. They argued that Parson has options: If the administration expands Medicaid, it has the legal authority to use more than $1 billion in federal incentives to cover the state’s share of the expansion cost for five years.

Through a spokeswoman, Parson declined to comment.

Two of the plaintiffs are single mothers and low-wage earners.

Autumn Stultz, of Springfield, earns minimum wage part-time, has chronic asthma and tonsil stones but cannot afford a doctor’s visit or surgery to treat the conditions, according to the suit.

Without the expansion, Stultz “will not have access to life saving preventative health care that is necessary considering the history of serious medical conditions in her family,” her attorneys wrote.

She earns between $3,382 and $17,420 a year for herself and her nine-year-old daughter, according to the suit, making her income too high to qualify for Medicaid under current rules. For a household of two, the expansion allows someone earning up to $24,039 a year to be covered.

St. Louis mother Stephanie Doyle earns a little more than that. According to the suit, she makes $12 an hour at a full-time job to support herself and her children. Under the current program, she wouldn’t be able to qualify for Medicaid with a household of her size unless she made less than $5,830 a year.

Without health insurance, Doyle has forgone medication for severe eczema, leading her to be “needlessly hospitalized” for bad flare-ups, the attorneys argued.

Threat of a lawsuit loomed over the regular General Assembly session this spring as the Republican supermajority repeatedly voted down about $130 million in state funds and $1.6 billion in federal money that Parson requested to pay for expansion.

A court fight became inevitable last Thursday when the governor informed the federal government it was withdrawing its expansion plan and will deny coverage to the newly eligible. Parson said last week the state was “unable to proceed with the expansion” without funding from lawmakers.

“This position has no merit,” the lawsuit claims. The budget does not distinguish between money for traditional MO HealthNet recipients and money for the newly eligible, wrote attorneys for the plaintiffs, who include private attorneys Chuck Hatfield and Lowell Pearson, and Joel Ferber of Legal Services of Eastern Missouri.

They also argue the state is violating a section of the constitution directing the Department of Social Services “to maximize federal financial participation” in paying for the state’s Medicaid program. In refusing to move forward with expansion, the state is missing out on the 90% contribution from the federal government under the Affordable Care Act, and the incentives offered in the latest Biden COVID-19 aid package.

Holding up expansion, according to the lawsuit, leaves the plaintiffs with untreated medical conditions for which they could have gotten coverage starting in July.

The third plaintiff, Melinda Hille, is a Fenton woman who has been unable to work because of Type 1 diabetes and other conditions that have landed her in and out of the hospital since 2015.

She’s been unable to get health insurance because Medicaid in Missouri currently does not cover adults of any income who are not diabled or do not have children.

Hille spoke in April at a rally for expansion at the state Capitol, detailing the “nightmare” of her initial diagnosis of Type 2 diabetes just as she was changing jobs and waiting to be hired full-time as a machine operator, a position that would have come with health insurance. It ended up being a misdiagnosis, which led to her getting medications for years that damaged her organs.

She needs six injections a day, but scrounged up enough money to visit low-cost clinics only every few months, she said. Now, she drives each week to St. Louis to get medications through a hospital patient assistant program, but still must pay for the prescriptions.

She said reuses her insulin needles to make them last. According to the lawsuit, Hille and her partner choose between paying for her treatments and buying food.

“The equipment just to have diabetes is so costly,” she said in April. “All I wanted was health care. All I wanted was insurance. And I wasn’t given that option.”

This story was originally published May 20, 2021 at 1:56 PM.