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Missouri governor nixes voter-approved Medicaid expansion plan

AP

Republican Missouri Gov. Mike Parson said Thursday that he will not expand Medicaid — a change approved by voters and scheduled to start July 1 — because lawmakers did not appropriate funding.

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if passed,” said Parson. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”

He sent a letter to the federal Centers for Medicare and Medicaid Services withdrawing the state’s expansion plan, saying Missouri will resubmit it should funding circumstances change.

Democratic state lawmakers and consumer advocates swiftly responded, saying the courts would force Parson to broaden coverage to low-income residents who make less than roughly $18,000 a year for an individual.

“By backtracking on implementation of Medicaid expansion, Gov. Parson is breaking his promise to the people of this state and violating his oath to uphold the Missouri Constitution,” tweeted state Rep. Crystal Quade, House minority leader. “Medicaid expansion will still happen as the constitution requires, but because of the governor’s dishonorable action, it will take a court order to do it.”

“We have every confidence that litigation will result in Medicaid expansion beginning on time for the 275,000 Missourians who will be eligible for health care,” said Jonathan Schleifer, executive director of The Fairness Project, which has focused on expanding Medicaid through ballot initiatives around the nation, including the newest efforts in Mississippi and South Dakota.

Expanding at the ballot box

Missouri became the sixth state to approve Medicaid expansion at the ballot box last August, when voters supported it by 53% to 47%. In Oklahoma, where voters narrowly approved expansion last June, newly eligible residents can start applying for coverage on June 1. It takes effect the following month.

Expanding Medicaid in Missouri would cost the state $130 million annually, said Amy Blouin, CEO of the left-leaning Missouri Budget Project. The federal government, which covers 90% of the cost, would provide the state with $1.7 billion a year.

Parson included a $1.9 billion funding request in his budget proposal to the General Assembly.

Blouin and other advocates argue that the state has sufficient funding for Medicaid and legislators do not need to appropriate money specifically for the expansion population. Plus, the American Rescue Plan, which Congress approved in March, offers an incentive for states to expand, which would bring in another $1.1 billion over the next two years, she said.

“It really does pay for itself,” she said.

A Kaiser Family Foundation review of research found that expansion can result in state budget savings by offsetting costs in other areas, reduced uncompensated care costs for hospitals and clinics, and gains in employment.

Other than Missouri and Oklahoma, another 12 states have yet to expand Medicaid. All have Republican governors or GOP-controlled legislatures.

More than 2 million uninsured adults fall into the “coverage gap,” meaning their incomes were too high to qualify in their states but too low to make them eligible for Affordable Care Act premium subsidies, which are open only to those earning more than 100% of the poverty level in non-expansion states.

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