Without funding from lawmakers, Gov. Parson preparing for Missouri Medicaid expansion

While Missouri lawmakers refused to pay for a voter-approved plan to extend Medicaid eligibility to an estimated 275,000 low-income Missourians in July, Gov. Mike Parson’s administration has been taking steps to set up the program’s expansion.

The Department of Social Services in April filed a proposed rule change with the Secretary of State’s office to let adults between the ages of 19 and 64 to receive benefits under the state health program, known as MO HealthNet.

The purpose is to allow faster enrollment of those newly eligible under the constitutional amendment voters passed last August to expand Medicaid, the proposal states. The rule change is scheduled to be published next Monday, which will begin a public comment and review process before it is finalized.

Between the proposal’s filing and its publication, the Missouri General Assembly sent Parson a budget that does not include funding he requested for the expansion, throwing the future of the plan into question. He has not publicly said whether he will move ahead with expansion without the money.

Asked if the proposed rule change indicates the state will allow the newly eligible to enroll in July, Parson’s spokeswoman Kelli Jones repeated a previous statement: “We will assess our options and legal requirement on how to move forward with Medicaid expansion.”

In Oklahoma, voters also passed a constitutional amendment last year to expand Medicaid. Lawmakers still haven’t funded the plan, but the state has announced that signups will start in June.

Parson opposed the expansion but said he would implement the will of the voters and asked lawmakers to fund it. The administration in February submitted a proposal for the expansion to the federal government. It has not yet been approved.

In a last-ditch effort to urge funding the expansion in the budget last week, Rep. Sarah Unsicker, a Shrewsbury Democrat, said on the House floor that Department of Social Services officials recently told her they were training workers for the expansion and that not paying for it gave the department a “difficult choice.”

Not allowing new enrollees invites a lawsuit against the state for violating the constitutional provisions for Medicaid eligibility. But without funding for the new recipients, the program would likely run out of money midway through the fiscal year that begins in July, which would force Parson to ask lawmakers to approve money they’ve already rejected.

The department’s proposed rule states the expansion would cost $1.85 billion, more than the $1.6 billion Parson proposed in his budget. The vast majority of that money comes from the federal government, under the Affordable Care Act.

Missouri’s Medicaid program currently has one of the nation’s strictest eligibility rules. It does not cover most non-disabled adults without children. Parents can qualify if their household income is no more 21% of the federal poverty level. In 2021, that’s less than $5,000 a year for a family of three.

Expansion would allow Missourians making up to 138% of the federal poverty level -- or a little under $18,000 a year -- to enroll.