The Missouri Department of Social Services must allow newly eligible residents that qualify for benefits under voter-approved Medicaid expansion to enroll and cannot impose greater restrictions on them, a Cole County judge ruled Tuesday.

Cole County Circuit Court Judge Jon Beetem sided with the plaintiffs who urged him to allow Medicaid expansion to take effect as soon as possible, rather than allow the state to make its case for why it needs two more months to begin accepting newly-eligible residents.

Attorneys for the state argued last week that while implementation was underway, that it would be difficult to immediately begin carrying out Medicaid expansion and said computer systems and personnel still needed to be put in place. John Sauer, the solicitor general of Missouri, requested Beetem grant another hearing for witnesses from MO HealthNet and the Family Support Division within DSS to testify to that point.

However, attorneys who represent three women who would have qualified for coverage under the expanded Medicaid program that voters approved in August 2020, said doing so would continue to allow the state to violate the law.

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

A spokeswoman for DSS did not immediately respond to a request for comment last week on whether the department has paused processing or denied new applications it has received since July 1 from newly eligible residents who qualify under Medicaid expansion.

Last month, the Missouri Supreme Court overturned Beetem’s earlier ruling, unanimously ordering Missouri to expand Medicaid to the approximately 275,000 residents who became eligible when it would have gone into effect July 1.

By allocating funds for the Medicaid program, the state must allow all eligible to access those benefits — and cannot differentiate between eligible populations, like those who previously qualified versus those newly eligible.

Under the constitutional amendment passed last year, 19 to 64-year-old adults whose household incomes are 138 percent of the federal poverty guideline or less would qualify for benefits under Missouri’s Medicaid program.

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

Despite passing with 53.3 percent of the vote, lawmakers refused to appropriate the $1.9 billion in state and federal funds needed to finance Medicaid expansion. In May, the state ultimately withdrew a plan it had submitted to federal regulators as a result.

Part of plaintiffs’ request was that Beetem order the state to submit a new state plan amendment — which attorneys for the state indicated DSS plans to do and have apply retroactively to July 1, the date Medicaid expansion would have gone into effect.

Parson said his administration is making plans to move forward, in addition to preparing to resubmit a state plan amendment to the federal government — “but we really cannot until we find out: do we have the ability to do that,” Parson told St. Louis Public Radio’s “Politically Speaking” last week.

“What I really don’t want is some judge deciding for us how we’re going to implement this from an area he has no experience in,” Parson said. “And the other thing, if we do have to implement — if we do — I don’t want to be in a position where we lose the 90 percent match from the federal government. And that’s a reality.”

Under the Affordable Care Act, states pay 10 percent of the costs of newly eligible Medicaid participants, with the federal government matching the remaining 90 percent.

Parson said he will not currently call a special session to allocate additional funding unless there’s a solution. He also said he does not want a repeat of cuts to Missouri’s Medicaid rolls that former Republican Gov. Matt Blunt pushed in 2005which ended up booting tens of thousands of people off Medicaid who had already signed up. But Parson said if there is no additional funding appropriated to fund Medicaid expansion, it could be a reality.

“And in this particular instance it’s even worse, because now you’re talking about able-bodied adults,” Parson told St. Louis Public Radio. “And are you going to take somebody that’s disabled off the system? Are you going to take somebody else that has health issues off of that for an able-bodied adult? I don’t think anybody wants that.”

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