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Lawmakers Say Special Session Likely Unneeded to Fund Missouri Medicaid Expansion Supplemental funding can likely wait until the next regular session that starts in January

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Above image credit: Demonstrators stand outside of the Governor’s Mansion in Jefferson City on July 1, 2021 and hold signs urging Gov. Mike Parson to fund voter-approved Medicaid expansion. (Tessa Weinberg | Missouri Independent)
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Legislative leaders of both parties said Tuesday that a special session is likely not needed to appropriate additional funds following a court order to begin covering Missourians who are eligible under voter-approved Medicaid expansion.

Senate Appropriations Committee Chairman Dan Hegeman, R-Cosby, Senate Minority Leader John Rizzo, D-Independence, and Rep. Peter Merideth, D-St. Louis and ranking minority member of the House Budget Committee, all said any supplemental funding can wait until the next regular session that starts in January.

The approximately $12 billion appropriated for the state’s Medicaid program will likely be sufficient to cover eligible Missourians until lawmakers can return, they said.

By that time, lawmakers will have a clearer idea of the total costs, which will depend on how many newly-eligible Missourians eventually enroll.

“I don’t know if there’s any need right now to do a special session,” Hegeman said.

Cole County Judge Jon Beetem
 Cole County Judge Jon Beetem. (screenshot courtesy of KRCG-TV)

The lawmakers’ predictions came shortly after Cole County Circuit Court Judge Jon Beetem ruled Tuesday that Department of Social Services officials cannot deny the approximately 275,000 Missourians that qualify for benefits from enrolling and cannot impose greater restrictions on their care than current Medicaid clients.

While the courts have affirmed that Missouri must move forward with Medicaid expansion, it remains a question of when state lawmakers will authorize additional funding to pay for it long-term.

“We all know what the obstacle is,” Gov. Mike Parson told reporters Tuesday after the judge’s ruling was issued. “We don’t have the funding to support it right now. So we’ve got to figure out how we’re going to do that, you know, whether we’re going to dilute the pool of money that we have now for the people that’s on the program, and just how we’re going to move forward.”

This past legislative session, lawmakers refused to appropriate the estimated $1.9 billion in state and federal funds needed to finance Medicaid expansion. Parson withdrew paperwork submitted to federal regulators necessary to implement expansion, citing the lack of funding.

The lawsuit finalized Tuesday was the result, with Beetem initially declaring the initiative that put expansion on the ballot to be unconstitutional.

But last month, the Missouri Supreme Court overturned Beetem’s earlier ruling, and said in a unanimous decision that by allocating funds for the Medicaid program, the state must allow everyone eligible to access those benefits — and cannot differentiate between those who previously qualified versus those newly eligible.

Rep. Rasheen Aldridge, D-St. Louis, sent a letter to Parson Tuesday urging him to call a special session for lawmakers to appropriate additional funding. Aldridge wrote that expansion had been put off for far too long already — noting it would help benefit Missourians, especially people of color and those in high poverty communities, amid the pandemic.

“We have a responsibility now to do what should have been done earlier this year during the budget process,” he wrote. “You hold the authority to ensure the General Assembly does not let this essential program go unfunded. I encourage you to use it.”

Parson told St. Louis Public Radio’s “Politically Speaking” last week, that he will not call a special session to allocate additional funding unless there’s a plan in place. He also said he did not want to lose the 90% match the federal government pays for the costs of newly eligible Medicaid participants.

A spokeswoman for the governor’s office did not immediately respond to a request for comment Tuesday on whether Parson is considering calling a special session.

House Budget Chairman Cody Smith, left, and Senate Appropriations Chairman Dan Hegeman confer with legislative staff during a conference committee hearing on the state budget on May, 5, 2021
 House Budget Chairman Cody Smith, left, and Senate Appropriations Chairman Dan Hegeman confer with legislative staff during a conference committee hearing on the state budget on May, 5, 2021. (Tim Bommel | Missouri House Communications).

Hegeman said he has been in conversations with House Budget Chairman Cody Smith, R-Carthage, and the governor’s office to determine when the legislature should meet to appropriate funds. 

He said he would have to see whether he would support a special session if it’s deemed necessary.

“We’d have to find consensus within the legislature to move in that fashion,” Hegeman said. “And we’ve just not even had that discussion yet.”

Both Rizzo and Merideth said they would support a special session if it turns out additional funds are needed.

“There’s ample amounts of money and ways to do it,” Rizzo said. “We don’t need to even get into the discussion of, ‘where are the triggers,’ and ‘where to do this or that.’ They have plenty of money to be able to do it. And they need to do it. And they need to do it now.”

Merideth said he doesn’t expect expansion to require additional appropriations of general revenue. The social services department simply needs spending authority to use federal matching funds that will come to the state.

Parson’s January budget proposal estimated expansion would cost $130 million in general revenue, $1.65 billion from federal funds and additional funding from sources like taxes on medical providers.

However, since then Congress passed the American Rescue Plan, which cut states’ share of their existing programs by 5% if they expand their Medicaid programs. That would save Missouri more than $1 billion over the next two years.

Rep. Peter Merideth
 Rep. Peter Merideth, a St. Louis Democrat, takes a photo outside of the Governor’s Office in the Capitol on Thursday, July 1, 2021. Merideth hoped to deliver to Gov. Mike Parson a box of messages from Missourians on the issue of Medicaid expansion. (Tessa Weinberg | Missouri Independent)

“There’s no compromise that we have to come up with. There’s no spending cuts we have to come up with. There’s no funding source we have to come up with. It’s all right there,” Merideth said. “And it’s in fact required by the Constitution that we do that, because it says we have to maximize the federal dollars we can leverage.”

Hegeman, Rizzo and Merideth all said that they do not anticipate cuts to increased provider rates that many Republican lawmakers had argued would help support existing Medicaid clients, in order to pay for Medicaid expansion.

It is uncertain when the social services department will begin accepting new enrollees. Meredith said the department has told lawmakers that it will begin right away. A spokeswoman for DSS did not immediately respond to a request for comment.

Attorneys for the state tried to delay Beetem’s Tuesday order, arguing that the department needed two more months to stand up additional computer systems and personnel.

Hegeman, who voted against appropriations for Medicaid expansion during the legislative session, said the fight is over.

“Now we just got to get through the mechanics of it and how do we move forward after it’s been resolved that the issue is constitutional,” Hegeman said. “Now it’s time to move forward. Move on.”

Tessa Weinberg covers education, health care and the Missouri legislature for the Missouri Independent, a nonpartisan, nonprofit news organization covering state government, politics and policy.

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