Missouri abandons voter-approved Medicaid expansion

Less than a year after Missouri voters approved a constitutional amendment expanding Medicaid coverage, Gov. Mike Parson (R) said Thursday he will drop plans to implement the expansion after legislators refused to provide funding.

Parson sent a letter to the federal Centers for Medicare and Medicaid Services formally withdrawing plans to expand MO HealthNet, the state’s Medicaid program. He said the legislature’s refusal to fund the expansion threatened the entire program’s fiscal solvency.

“Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if it passed. The majority of Missouri voters supported it, and we included funds for the expansion in our budget proposal,” Parson said in a statement. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time.”


Voters approved the amendment to the state constitution, which would have expanded Medicaid eligibility to those whose income was under 138 percent of the federal poverty level under the Affordable Care Act, by a 53 percent to 47 percent margin in August.

But a Missouri court ruled in June that because the measure did not have a funding mechanism, it would be up to the General Assembly to dedicate a funding stream. Parson included a $1.9 billion funding request in his budget proposal earlier this year.

The legislature voted against allocating that funding last month after a pitched battle among state Senate Republicans, who were divided over the expansion.

Supporters of the expansion say the state has no choice but to broaden access and that they intend to take the matter to court.

“Missouri's constitution is crystal clear: Medicaid expansion must begin on July 1,” said Jonathan Schleifer, executive director of The Fairness Project, a group that backed the amendment. “Gov. Parson's announcement today that he intends to ignore the will of Missouri's voters and violate the state constitution makes this a matter for Missouri's courts to resolve. We have every confidence that litigation will result in Medicaid expansion beginning on time for the 275,000 Missourians who will be eligible for healthcare.”

Thirty-eight states and the District of Columbia have expanded Medicare under the Affordable Care Act, a decade after its passage. Oklahoma voters passed a ballot measure to expand Medicare in 2020, and the Centers for Medicare and Medicaid Services approved their proposal in December.

Supporters of Medicaid expansion are also seeking to put the question on the ballot in Florida, one of the 12 states that has not adopted the broader eligibility standards. Those backers are trying to qualify for the ballot in 2022.