Medicaid expansion has finally begun in Missouri, nearly five months after Republican Gov. Mike Parson unsuccessfully tried to block it.
Roughly 275,000 low-income adults in the state are now eligible for coverage. MO HealthNet, the state’s Medicaid program, has already received more than 17,000 applications since the sign up process started in August.
Missouri was required to expand Medicaid after voters approved it in August 2020 by a vote of 53% to 47% – becoming the sixth state to accept the Affordable Care Act provision at the ballot box.
It was supposed to take effect on July 1 but was halted by Parson, who said in May that the state could not proceed because lawmakers had not appropriated funding.
A legal battle ensued, with plaintiffs arguing that the state’s Medicaid program has been funded by the General Assembly and that lawmakers do not need to set aside specific money for expansion enrollees.
A lower court found that the 2020 ballot measure approving expansion had violated state law, but that decision was overturned in July by the state Supreme Court, which declared in a unanimous ruling that the ballot initiative was constitutional.
Extra federal funding
Missouri is also eligible to receive an estimated $968 million in additional federal Medicaid funding over the next two years, as part of an American Rescue Plan measure aimed at encouraging holdout states to expand their programs.
Oklahoma also qualifies for a federal infusion after Medicaid expansion coverage began there on July 1. Voters narrowly approved the ballot initiative in 2020.
However, the remaining 12 states that have yet to expand Medicaid have not announced any plans to take Congress up on its offer. All have Republican governors or GOP-controlled legislatures.
More than 2 million uninsured adults fall into the “coverage gap,” meaning their incomes are too high for them to qualify for Medicaid in their states but too low for them to be eligible for subsidies to help with Affordable Care Act premiums. The subsidies are open only to those who earn more than 100% of the poverty level in non-expansion states.
Democrats in Congress are looking to enact a federal Medicaid expansion program to cover low-income residents in the holdout states as part of their $3.5 trillion budget reconciliation package. However, the provision may not survive the cuts lawmakers are expected to make to garner sufficient votes for passage.