State asks judge to delay Missouri Medicaid expansion for two more months


The Missouri Supreme Court ruled last month that the state must expand Medicaid as voters approved in 2020.

Now it’s just a question of when.

On Friday, attorneys representing plaintiffs who would have qualified for coverage urged Cole County Circuit Court Judge Jon Beetem to effectuate what the state’s highest court ordered and prohibit the Department of Social Services from denying eligible individuals from enrolling or treating them differently.

“‘Don’t deny,’ that’s what we’re asking you to tell them,” attorney Chuck Hatfield told Beetem. “Don’t deny.”

However, attorneys for the state argue implementing Medicaid expansion for the approximately 275,000 newly eligible residents will be a tedious, complicated process that will require at least two additional months of preparation to stand up the computer systems and personnel needed.

John Sauer, the solicitor general of Missouri, requested Beetem hold another hearing for the state to demonstrate that point and call witnesses from MO HealthNet and the Family Support Division within DSS. 

Implementation “is a complicated process that is already underway but is going to take more time,” Sauer said.

The Missouri Supreme Court overturned Beetem’s ruling last month and said in a unanimous decision that by providing funding for the Medicaid program, Missouri must allow everyone eligible to access those benefits — and cannot differentiate between those previously eligible versus the newly expanded population.

In August 2020, Missouri voters expanded Medicaid eligibility to 19 to 64-year-old adults whose household incomes are 138 percent of the federal poverty guideline or less.

That is $17,774 a year for a single person, or $36,570 for a family of four.

But lawmakers refused to appropriate the $1.9 billion in state and federal funds needed, resulting in the state withdrawing a plan it had submitted to federal regulators.

Hatfield said he understands that implementation will not be immediate and assumes the state will operate in good faith to get the program up and running. But he argued that the state is requesting an order that will allow them to continue to violate the law.

“They were within six weeks of implementation,” Hatfield told reporters after Friday’s hearing, in reference to when the state plan was withdrawn. “And now they say they need at least another two months to implement. We don’t think that’s the case.”

Hatfield said even if Medicaid recipients’ applications are not yet approved, it’s necessary for the program’s implementation to begin because Medicaid could still end up paying for emergency services or pharmaceuticals. And if the state waits additional months, it likely won’t be until the end of the year that the program will reach newly eligible residents.

Sauer argued that attorneys for the plaintiffs were asking for a class-action decision, when they only represent three individuals in their lawsuit.

“However, we understand that the Missouri Supreme Court’s decision is the law and in fact the department is working already to implement it as quickly as it possibly can,” he said.

Hatfield also requested that Beetem direct the state to file a state plan amendment. Beetem raised questions if determining eligibility and then enrolling those who qualify would require a change to that plan.

Hatfield said it would not and that the state plan amendment can apply retroactively to July 1 once approved. However, Sauer said his understanding was that the state plan amendment must be approved before enrollment could begin.

Friday’s hearing lasted less than 20 minutes, and Hatfield said he’s optimistic Beetem will issue a decision on next steps in a few business days.

“The state’s position is, he should enter an order that we come back later and talk about this more,” Hatfield said. “And I’m ready to quit talking about it.”

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