JEFFERSON CITY — A proposed resolution with the potential to reverse Missouri’s Medicaid expansion is headed to the Senate for debate.
HJR 117 would amend the state’s constitution to make eligibility for working-age adults on Medicaid in Missouri subject to whether the General Assembly makes an appropriation each fiscal year. The resolution has the potential to gut Missouri’s Medicaid expansion, approved by voters via ballot initiative in 2020.
The Senate Appropriations Committee on Wednesday moved to pass the resolution on to the full Senate by a vote of 8-5. If passed by the Senate, the resolution will appear as a ballot initiative for Missouri voters.
Committee members in opposition to the resolution said the measure was unfair to voters, who already voted to expand Medicaid eligibility in 2020 through a different ballot initiative. That measure opened eligibility up to individuals and families with incomes up to 138% of the federal poverty level. For a family of three, that is $31,781.
Sen. Lauren Arthur, D-Kansas City, said the resolution was “disrespectful to voters” and “cruel” to those who are still in the process of enrolling in Medicaid — “many of whom have not successfully enrolled and they’ve had to put off medical care because they’re scared of going into medical debt.”
“It seems pretty clear that this is an attempt to undo what voters approved with Medicaid expansion,” Arthur said. “This allows the General Assembly to not fund that expanded population.”
The General Assembly had debated expanding Medicaid for years before the 2020 initiative. Prior to that vote, only low-income adults who were elderly, disabled or had children qualified for MO HealthNet, making Missouri’s Medicaid eligibility requirements some of the strictest in the nation. Supporters of expansion estimated a gap of around 250,000 Missouri residents who didn’t qualify for Medicaid but could not afford private insurance.
Last year, conservative Republicans blocked efforts to fund Medicaid expansion, and Gov. Mike Parson decided not to implement the program because of the lack of money. The state Supreme Court later ruled that because the ballot initiative made Medicaid expansion part of Missouri’s Constitution, a lack of appropriated money did not mean the program could be halted.
“Frankly, I am tired of reading stories of Missourians that have died because they didn’t have access to health care,” Arthur said. “And that is the result of callousness of some so-called leaders in the General Assembly. And I do not want to debate this issue for another minute.”
Sen. Karla May, D-St. Louis, said the 2020 ballot initiative was a recourse after years of inaction by the legislature. She argued the state has enough money to fund an expanded Medicaid for the next six to 10 years, and with proper investment, it will be able to plan ahead and continue covering the health costs of vulnerable populations.
“Sometimes, the voters are smarter than the people they elect,” she said.
Sen. Bill Eigel, R-Weldon Spring, argued the new resolution would ask for “further clarifications” for MO HealthNet, the state’s Medicaid system, which he said is plagued by inefficiencies.
“Our Medicaid program is one of the most poorly run, inefficient, massive government programs not just in Missouri state history, but maybe in the history of all state government in the entire history of the United States,” Eigel said. “Not only does it waste billions of dollars every single year, but it is on a path to unsustainability that the folks calling for no restrictions or reforms against this program and want to throw more money at this program will lead it to insolvency faster and hurt more people more greatly.”
The committee’s vote comes amid a time when MO Health Net — along with other services administered by the Department of Social Services — is experiencing a massive backlog in enrollment applications. The most recent department data shows an average processing time of 119 days for some applicants.
The proposed constitutional amendment passed out of committee nearly on partisan lines, except for one Republican voting against it — Sen. Lincoln Hough, R-Springfield.