In a case that has received national attention, the Missouri Supreme Court has issued a unanimous decision that overturns a Cole County judge’s ruling that said the August Medicaid expansion ballot measure was unconstitutional.

Attorney Chuck Hatfield, who represents three low-income women, addresses Cole County Circuit Judge Jon Beetem on June 21, 2021 in Jefferson City (file photo courtesy of “News-Tribune” pool photographer Julie Smith)

The Supreme Court issued a 14-page decision on Thursday afternoon, just nine days after hearing 35 minutes of oral arguments in Jefferson City in the case. The speed of that decision highlights the importance of this case.

Cole County Circuit Judge Jon Beetem ruled in late June that Missouri’s August Medicaid expansion ballot measure was unconstitutional, because it did not contain a funding mechanism. The definition of “appropriation” was a key argument for both sides in the case.

Judge Beetem and Missouri Solicitor General D. John Sauer said the August Medicaid expansion ballot measure violated article III section 51 of the Missouri Constitution. The Supreme Court rejects that argument, writing that “by its plain language, article III, section 51 prohibits only initiatives that are used for the appropriation of money.”

The attorney for three low-income women suing Missouri, Chuck Hatfield, argued before the court that Missouri lawmakers approved Medicaid expansion when they approved the state’s $11 billion Medicaid budget. Hatfield says the voters have spoken, by approving Amendment Two in August.

The three plaintiffs are Stephanie Doyle of St. Louis, Melinda Hille of Fenton and Autumn Stultz of Springfield. They suffer from diabetes and skin conditions, and they have been asking the state Department of Social Services (DSS) to allow them to enroll and receive the same Medicaid coverage as those who currently receive it.

The final page of the Missouri Supreme Court’s Tuesday decision sums up this case in a paragraph. The court writes, in part: “DSS and Mo HealthNet are bound by article IV, section 36(c) concerning which individuals are eligible to enroll when it spends the appropriated funds. Consequently, DSS has appropriation authority to provide services for all individuals eligible for Mo HealthNet, including individuals eligible for coverage and services pursuant to article IV, section 36(c).”

That indicates the Supreme Court agrees with Counselor Hatfield’s argument that the Missouri Legislature frequently has to approve supplemental budgets, when funding for a specific state department runs out.

Hatfield was joined at the Missouri Supreme Court’s July 13 oral arguments by attorney Joel Ferber of Legal Services of Eastern Missouri, who says Doyle, Hille and Stultz are struggling and just getting by. He says his clients are desperate, and that what’s at stake in this case is life-saving health care for prescription drugs, treatment and medical equipment and supplies for Missourians who need it.

As for Solicitor General Sauer, he reiterated to the Missouri Supreme Court that Missouri lawmakers rejected funding for Medicaid expansion numerous times this session, including in four House floor votes, two Senate floor votes, four different bills and eight proposed amendments.

Sauer noted that Governor Mike Parson (R) recommended more than $1.5 billion in his proposed budget for Medicaid expansion, but that the Legislature approved nothing for it.

Missouri’s Medicaid expansion lawsuit case is a high-profile one that impacts about 275,000 potential new Medicaid recipients. Medicaid is a federal and state program that assists with medical costs for residents with limited incomes.

53 percent of Missouri voters approved Medicaid expansion in August. However, it failed in 107 of Missouri’s 114 counties. The opposition to Medicaid expansion has primarily come from rural GOP lawmakers who represent those districts. They say Missouri cannot afford Medicaid expansion and have warned that other programs will be cut, when expansion is implemented.

Supporters of Medicaid expansion include the Missouri Chamber of Commerce and business groups in St. Louis, Kansas City and Springfield. They say that Medicaid expansion would create 16,000 new jobs in Missouri. They also say that Arkansas has saved $444 million from Medicaid expansion and that Montana has saved more than $50 million. The groups say Medicaid expansion would provide healthcare to Missourians who earn less than $18,000 annually.

The Missouri Supreme Court’s July 13 oral arguments in Jefferson City were the first ones for new Missouri Supreme Court Judge Robin Ransom. They were also the first ones for the new Missouri Supreme Court Chief Justice, Paul C. Wilson.

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