A judge in mid-Missouri’s Cole County has ruled that Missouri’s August Medicaid expansion ballot measure is unconstitutional. A lawyer for three women suing Missouri over Medicaid expansion is appealing.

Missouri Solicitor General D. John Sauer addresses Judge Jon Beetem in Cole County Circuit Court in Jefferson City on June 21, 2021 (photo courtesy of Jefferson City News-Tribune pool photographer Julie Smith)

Medicaid is a federal and state program that assists with medical costs for residents with limited incomes.

Cole County Circuit Judge Jon Beetem says Amendment Two requires appropriation of revenues not created by the initiative. While 53 percent of Missouri voters approved Medicaid expansion in August, the measure did not contain a funding mechanism, according to Beetem.

In his six-page ruling, Judge Beetem says Amendment Two would create a class of 275,000 new Medicaid recipients, and says the estimated cost for the expansion is more than $1 billion.

Judge Beetem says Missouri’s Constitution says that state revenues cannot be expended without an appropriation. The judge cites language in Article III, section 51 of the Missouri Constitution, writing that it “provides that the people, by initiative, may only spend or appropriate the revenues that they raise in the initiative.”

Missouri’s Medicaid expansion lawsuit is now heading to the Court of Appeals or to the state Supreme Court, after the ruling.

State Sen. Denny Hoskins (R-Warrensburg), who led the legislative fight against Medicaid expansion, praises Judge Beetem’s ruling.

“I was very pleased to hear Judge Beetem’s ruling that basically said what I said all along, that if there’s a voter referendum that has a fiscal note, then there also needs to be a mechanism in that question, in that voter referendum, that would pay for that voter referendum,” Hoskins tells Missourinet.

The attorney for the three women suing Missouri, Chuck Hatfield, is appealing. He’s issued a statement, in response to the decision.

“We believe the Court of Appeals has already decided, in the Cady case, that Amendment 2 was a valid use of the initiative process and that it did not unlawfully appropriate funds,” the statement reads, in part.

The reference to “Cady” involves a 2020 court case titled Cady vs. Ashcroft. It was a pre-election challenge to the Medicaid expansion ballot measure.

Counselor Hatfield also says Judge Beetem found that the initiative was not validly enacted because it used the initiative to appropriate. Hatfield says the state did not raise that issue at Monday’s trial.

The American Cancer Society Action Network has issued a statement, expressing disappointment in the ruling. “Cancer patients cannot wait for further legal battles to access the lifesaving coverage that Medicaid expansion provides,” the organization says.

Judge Beetem heard about 75 minutes of arguments on Monday in Jefferson City, before a packed courtroom. The three women suing the state note Missouri voters approved Amendment Two in August. Counselor Hatfield wanted Judge Beetem to issue an injunction that would allow his three clients and others like them to be enrolled in Medicaid on July 1. He argued that there is no expansion population, and that there was an August election where Missourians voted to amend the Constitution.

State Solicitor General D. John Sauer said in court Monday that Missouri lawmakers voted against Medicaid expansion four times this session and that it would take three appropriations bills to approve Medicaid expansion, including money for the Office of Administration (OA) budget.

Hatfield also told the judge Monday that the Missouri Supreme Court issued a 2020 ruling involving Planned Parenthood of the St. Louis region, ruling that any attempt to use an appropriation bill to amend general laws violates the state Constitution. Hatfield says the August election result can only be changed by statute or by another constitutional amendment, similar to what happened after the “Clean Missouri” vote.

The three women, Stephanie Doyle of St. Louis, Melinda Hille of Fenton and Autumn Stultz of Springfield, want the state Department of Social Services (DSS) to allow them to enroll and receive the same Medicaid coverage as those who currently receive it. Court documents indicate the women suffer from numerous health conditions, including diabetes and severe skin conditions.

The Missouri Legislature gave final approval in May to a $35 billion state operating budget. Legislative supporters of Medicaid expansion say it would help the working poor across the state. They say Amendment Two would provide healthcare to Missourians who earn less than $18,000 annually.

While it passed statewide with 53 percent of the vote, Amendment Two failed in 107 of Missouri’s 114 counties. The opposition to Medicaid expansion has primarily come from rural lawmakers in districts that voted against Medicaid expansion.

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