Medicaid Expansion Missouri Style Update

Judge Jon Beetem of the Cole County Circuit Court has ruled, in a fairly cryptic opinion, that he lacks the authority — at the intersection of Amendment 2; the Missouri State Constitution; and Medicaid finance practices — to order the legislature to appropriate the funding he notes would be required if an appropriation had not already been made. Here I am trying to explain that one

Medicaid Expansion: Missouri Style

I had to laugh when a reporter asked me, this morning, what you would say in response to a “what’s the problem?” question on Missouri’s Medicaid expansion.

What’s the problem, you say?

First, Medicaid expansion by referendum is the difficult path because no coalition of legislators has formed to shepherd the expansion from theory to activation. Yes, I know, legislative compromise did not work here (nor in Oklahoma) but it is, nevertheless, the more difficult path.

Second, why would the Governor seek waiver and all the accommodation necessary to expand Medicaid consistent with the summer of 2020 referendum by reaching out to HHS in February of 2021 only to retract his request — after huge sums of money, time, and effort had been invested for a July 2021 referendum-mandated roll out– in May, 2021 in the name of fiscal responsibility?

Third, after all, if everyone can have their own guestimate on what Medicaid expansion would cost Missouri in the short term or the long term, shouldn’t respectably-sourced data indicating that the federal government cost share of 90%, sweetened even more recently by COVID-19 relief legislation would render Medicaid expansion a budget neutral act, count for something? Or, maybe not.

Maybe, as I have written elsewhere, this is all about the transformation inherent in expansion of Medicaid under the ACA from a program for the worthy poor to a program that casts no judgment on the relative worthiness of the recipient. And that’s what it is all about.