Time to ‘get going’ on Medicaid expansion, attorney says as Missouri asks for two months

Medicaid expansion was supposed to begin July 1, and the state Supreme Court upheld the voter-approved plan. But Missouri officials said Friday that they still need two months before accepting newly eligible low-income residents into the program.

Missouri solicitor general Dean John Sauer told a Cole County judge that the state and Medicaid expansion advocates have “radically different expectations” of how long it would take for the program to be set up.

The advocates have asked Cole County Circuit Judge Jon Beetem to order that enrollment begin immediately.

They expect Beetem to decide on the matter in the new few days.

The matter is back in Beetem’s hands after a unanimous ruling by the Supreme Court last month that the state is obligated to follow the constitutional amendment approved by voters in 2020 and enroll the estimated 275,000 who are eligible.

Gov. Mike Parson had planned to implement the expansion, but nixed it when the Republican-dominated state legislature refused to budget funds for it. Three low-income women who would qualify under the amendment sued Parson’s administration.

After an initial loss before Beetem, they won their case in the Supreme Court, which ruled that the money lawmakers budgeted for the existing Medicaid program does not distinguish between prior recipients and new ones.

The women’s attorney, Chuck Hatfield, is asking Beetem to order the state not to deny those clients coverage and not to treat them differently from traditional Medicaid recipients.

But Sauer called the implementation a “complicated process” that “is already underway but it is going to take more time.” He wants Beetem to hold another hearing in which Sauer could call two Medicaid officials to testify on what work the state still needs to do before accepting new recipients. That includes improving its computer system, hiring new personnel and resubmitting a document to the federal Centers for Medicare and Medicaid Services outlining the additional federal funding the state will get for the expansion, he said.

Hadfield urged Beetem to reject the state’s position.

“The state wants you to take evidence on why they cannot comply with the law,” Hatfield said. “I don’t think that’s appropriate.”

He told reporters he agrees it will take time before the state has fully enrolled all new applicants, but it should start now.

He pointed out the Parson administration had already been working to implement expansion this spring before the legislature blocked funding. By the time Parson called it off in May, there were only six weeks until the expanded eligibility was to begin July 1, less time than the two months Sauer now says the state needs.

“If it takes that long in good faith, and there’s nothing malicious or improper about it, so be it,” Hatfield said. “But we need to get going.”

In comments to St. Louis Public Radio, Parson said this week the state does intend to re-file the expansion documents with the federal government and prepare for the implementation. He urged lawmakers to give the state authority to spend the additional federal funds and to plan for the state budget to include the new enrollees.

Medicaid expansion will allow Missourians earning up to 138% of the federal poverty level to be covered -- about $17,700 for a single person and $36,570 for someone in a family of four.

This story was originally published August 6, 2021 at 2:51 PM.