Missouri Supreme Court rules in favor of Medicaid expansion

The Missouri Supreme Court on Thursday ruled in favor of supporters of Medicaid expansion in the state, overturning a lower court ruling that had blocked it. 

The unanimous ruling was quickly praised by supporters of Medicaid expansion, who said it would mean that expansion can finally go forward in the state after a long battle. 
 
“As a result of the Supreme Court’s ruling, Missourians across the state will finally be able to realize the health and economic benefits of Medicaid expansion," the Missouri Budget Project said in a statement. "State after state has shown that in addition to providing insurance to those eligible, expansion is a fiscal and economic boon to state economies and budgets."
 
An estimated 275,000 people in Missouri could gain coverage under the expansion of Medicaid's eligibility. 

Voters passed a ballot question last year approving the expansion of Medicaid under the Affordable Care Act, but GOP Gov. Mike Parson said in May he would not implement it after Republicans in the state legislature declined to provide funding for it. 
 
Supporters then sued to seek implementation. A lower court ruled against expansion in June, saying the ballot measure had actually been unconstitutional because it appropriated money without providing a funding source. 
 
But the state's supreme court overturned that ruling on Thursday, saying that the ballot measure did not directly appropriate money and infringe on the legislature's appropriations power, even if it ends up costing money. A lower court is tasked with issuing an order to implement the ruling. 
 
Missouri would be the 38th state to expand Medicaid, with 12 states still holding out. 
 
Democrats in Congress are currently exploring ways to have the federal government step in and provide coverage in the 12 holdout states, a measure that could be included in the coming infrastructure package using the fast-track process of reconciliation.