Destiny of Missouri Medicaid enlargement will quickly be within the fingers of the state Supreme Court docket • Missouri Unbiased

The Missouri Supreme Court building in Jefferson City (photo courtesy FLICKR / David Shane, licensed under CC BY 2.0).

In a few hours the most important moment in the Eight year battle for Medicaid expansion will happen. The clashes will end and 275,000 people’s health insurance will be in the hands of the Missouri Supreme Court.

The seven judges must decide whether or not to expand Medicaid eligibility in accordance with the constitutional amendment approved by the voters as Cole County Judge Jon Beetem ruledif it was fatally flawed because it did not contain a new source of income to cover the expected costs.

The only other court option suggested by Attorney General Eric Schmitt’s office in his final written letter is to leave individuals eligible for cover without actually providing them, unless lawmakers specifically fund it.

Although there is no deadline for the decision, the appeal was negotiated on an expedited schedule, as coverage was due to start on July 1st.

In the days and hours before the oral proceedings, which begin at 11 a.m., the judges received a lot of advice on how to decide. The final written arguments from Schimitt’s office demanding that the court uphold Beetem were filed on Friday. On Monday afternoon, the friend-of-the-court pleadings were filed along with the final motions of plaintiffs, who requested an order in favor of the enlargement.

From the first time then-Gov. Jay Nixon urged lawmakers in 2012 to extend Obamacare coverage to lower-income adults until this year there was never a realistic chance the Republican-dominated General Assembly would go along with it.

Adoption of Amendment 2 last August some opinions changed, but not enough. Governor Mike Parson, who opposed Amendment 2, proposed $ 1.9 billion for the expected cost, including $ 130 million in general revenue in his budget proposal for January. When the final vote on funding was held in the Missouri Senate in May, only four Republicans joined 10 Democrats in support of Parson’s request.

Since 1945, the Missouri Constitution has been prohibited initiatives that require funds if the same electoral measure does not generate the required income. In his briefing to the state, the Attorney General’s John Sauer argued that judges had only two options – determine that Amendment 2 is valid but subject to appropriation, or that it has not been validly enacted.

“This conflict is real and stubbornly opposes plaintiffs belated attempts to explain it away,” wrote Sauer.

Last year the court ruled that lawmakers cannot use appropriation accounts to invalidate Planned Parenthood for providing Medicaid-paid family planning services. Sauer called on the court to overturn that ruling and allow lawmakers to determine which legally eligible individuals receive Medicaid coverage and which do not.

The judges don’t have to stretch the logic that far, wrote Chuck Hatfield, Lowell Pearson, and other lawyers representing the three women sued on reporting. The women are entitled to claim, the legislature has confiscated funds for every service Medicaid and can therefore not be refused, wrote the lawyers.

“There is nothing ambiguous about a draft budget,” they wrote.

The cost of the program, whether for traditional Medicaid or the growing population, is uncertain each year, they wrote.

First, no one has any idea whether the amount of money that the General Assembly has approved is too much, too little or just right, they wrote. “The number of participants in the MO HealthNet program fluctuates from year to year, as does the amount and type of services used.”

The amicus curiae, or friend of the court, has come from conservative groups, health care providers, supporters of Amendment 2, and lawmakers. There’s even a secondary dispute in which Missouri House Democratic Leader Crystal Quade of Springfield and Kansas City Assistant Democratic Leader Richard Brown ask the court to reject, or at least ignore, the pleading filed on behalf of the entire House.

The stakes are enormous, both for those who would be covered and for the treasury.

On behalf of the state’s 12 state-qualified health centers serving 600,000 patients, Jim Layton, the state’s former chief appeal attorney, wrote that it is important that the clinics serve the paid patients to support their work for those without insurance .

Of the people who use them, he writes, 46 percent are already on Medicaid and another 25 percent are uninsured. Many of the uninsured would be insured, he wrote, and lawmakers funded all of the services Medicaid provided.

“But the General Assembly cannot, by simply changing a dollar number on a line of a budget, change any parameter of the program constitutionally established on the initiative of the people, any more than it can by changing or including a dollar number.” Household bill to change the eligibility for another program, ”he wrote.

Before Amendment 2 was passed, Missouri was one of 14 states that had not expanded Medicaid under the Affordable Care Act of 2010. The law originally made the expansion mandatory, but the US Supreme Court ruled in 2012 that criminal provisions that made Medicaid an all-or-nothing program are unenforceable.

Under the terms of the ACA, the states pay 10 percent of the expansion costs and the federal government pays 90 percent. Missouri pays about 35 percent of the costs in the traditional Medicaid program.

Amendment 2 extended coverage to those ages 19-65 with household income less than 138% of the federal poverty line, or $ 17,774 per year for a single person and $ 36,570 for a household of four.

Under the current Medicaid program, adults without children are not eligible unless they are blind, have another qualifying disability, or are pregnant.

The traditional Medicaid program is expected to cost approximately $ 12 billion in the current fiscal year.

In his January budget, Parson estimated the total cost of expansion at $ 1.9 billion, of which $ 130 million was from general revenue, $ 1.65 billion from federal treasury, and the remainder from taxes on medical services.

If Missouri extends Medicaid coverage, it will be eligible for additional support for the traditional program, which is estimated to save the state $ 1.2 billion over two years.