Audio: Missouri Supreme Court to hear Missouri Medicaid expansion lawsuit case this morning

Medicaid Expansion in Missouri

The Missouri Supreme Court will hear oral arguments Tuesday morning, July 13, 2021, in Jefferson City in one of the biggest cases the court has faced in recent memory: Missouri’s Medicaid expansion lawsuit case. Oral arguments will begin Tuesday at 11 a.m.



Cole County Circuit Judge Jon Beetem ruled in late June that Missouri’s August Medicaid expansion ballot measure was unconstitutional because it did not contain a funding mechanism. Attorneys for three low-income women suing the state have appealed to the Missouri Supreme Court.

It’s a high-profile case that impacts about 275,000 potential new Medicaid recipients. At least ten of the Court briefs have been filed, by groups that support and oppose Judge Beetem’s decision.

Medicaid is a federal and state program that assists with medical costs for residents with limited incomes. In his six-page ruling, Judge Beetem says Amendment Two requires the appropriation of revenues not created by the initiative. While 53 percent of Missouri voters approved Medicaid expansion in August, the measure did not contain a funding mechanism, according to Beetem.

Judge Beetem says Amendment Two would create a class of 275,000 new Medicaid recipients and says the estimated cost for the expansion is more than $1 billion. He says Missouri’s Constitution says that state revenues cannot be expended without an appropriation. The judge cites language in Article III, section 51 of the Missouri Constitution, writing that it “provides that the people, by initiative, may only spend or appropriate the revenues that they raise in the initiative.”

The three women suing Missouri are Stephanie Doyle of St. Louis, Melinda Hille of Fenton, and Autumn Stultz of Springfield. They’re asking the state Department of Social Services (DSS) to allow them to enroll and receive the same Medicaid coverage as those who currently receive it. Court documents indicate the women suffer from numerous health conditions, including severe skin conditions and diabetes.

In his 57-page brief to the Missouri Supreme Court, Counselor Hatfield says Judge Beetem made several errors.

“The Circuit Court (Cole County Judge Beetem) purported to invalidate the law for which the majority of Missourians voted,” Hatfield writes in his Supreme Court brief. “That was an error. The Circuit Court ignored the distinction between substantive laws and appropriations, sua sponte reconsidered an on-point Court of Appeals decision, refused to adjudicate the question in front of it, and instead took the unprecedented step to hold a provision of the Constitution unconstitutional.”

Counselor Hatfield reiterates much of what he argued in Cole County Circuit Court in June. He writes that the three plaintiffs, Doyle, Hille, and Stultz, “fall squarely within the requirements as a matter of fact,” referring to eligibility under the August ballot measure. Hatfield says they are all between the ages of 19 and 64, with incomes below 138 percent of the federal poverty level for their applicable family size.

Hatfield also says the plain language from Missouri House appropriation bills 10 and 11 gives the state authority to expend money to provide Medicaid benefits to Missourians who are eligible under Amendment Two. He also says that the funding provided in bills 10 and 11 historically has not been sufficient to provide Medicaid funding for a full fiscal year. He notes it’s common for lawmakers to have to pass supplemental budgets, as yearly costs become more apparent.

Missouri Attorney General Eric Schmitt’s (R) office is representing the state in this case. Solicitor General D. John Sauer argued the case in late June in Cole County and will argue the case again Tuesday in Jefferson City.

Solicitor General Sauer outlines his arguments in a 77-page brief, to the Missouri Supreme Court. Like Counselor Hatfield, much of what Mr. Sauer has written was argued in court in June. But there are some new details, in the filing.

Sauer says numerous legislative efforts to expand Medicaid this past session in Jefferson City failed and provides more detail than what he told Judge Beetem in court.

“In sum, during the 2021 session, the General Assembly considered appropriating funds explicitly designated for Medicaid expansion in at least four different bills, eight proposed amendments, one House committee vote, four House floor votes, two Senate committee votes, and two Senate floor votes,” Sauer writes, in his Supreme Court brief.

He also writes that Governor Parson (R) recommended more than $1.5 billion in his proposed budget for Medicaid expansion, but that the Legislature approved $0 for it.

Sauer also says State Rep. Sarah Unsicker (D-Shrewsbury) offered an amendment to House Bill 11 that would have used only federal American Rescue Plan Act funds for Medicaid expansion. Sauer says that amendment failed. The American Rescue Plan Act is a federal bill signed by President Joe Biden (D) earlier this year.

Sauer also rejects Hatfield’s argument that the Court of Appeals decided in the Cady case that Amendment Two was a valid use of the initiative process. “Cady” involves a 2020 court case titled Cady vs. Ashcroft. It was a pre-election challenge to the Medicaid expansion ballot measure.

In his brief, Sauer rejects that argument for three reasons. His main argument is that Cady was a decision of the Court of Appeals and doesn’t bind the Missouri Supreme Court.

As for Counselor Hatfield, he says there is no expansion population, and that there was an August election where Missourians voted to amend the Constitution.

This Medicaid expansion case has attracted media interest from across the state. At least six television stations will be at the Missouri Supreme Court on Tuesday morning, along with print and radio reporters from across the state.

And at least ten friends of the Court briefs have been filed, by groups that support and oppose Judge Beetem’s decision.

One of them is from the Missouri Chamber of Commerce and business groups in St. Louis, Kansas City, and Springfield. Their brief says Medicaid expansion would create 16,000 new jobs in Missouri. They also say that Arkansas has saved $444 million from Medicaid expansion and that Montana has saved more than $50 million.

Another filing is from Jeremy Cady and Americans for Prosperity, which agrees with Judge Beetem’s decision. In its friend of the court brief, Americans for Prosperity says courts have consistently held that the state Constitution prohibits elections on initiatives that mandate spending without new revenues.

The Missouri Legislature gave final approval in May to a $35 billion state operating budget. Legislative supporters of Medicaid expansion say it would help the working poor across the state. They say Amendment Two would provide healthcare to Missourians who earn less than $18,000 annually.

While it passed statewide with 53 percent of the vote, Amendment Two failed in 107 of Missouri’s 114 counties. The opposition to Medicaid expansion has primarily come from rural lawmakers in districts that voted against Medicaid expansion.

There is no timeframe on when the Missouri Supreme Court will issue a ruling in Tuesday’s case.

Click here to listen to Missourinet’s Bill Pollock and Brian Hauswirth discuss Judge Beetem’s ruling in detail, during a June 25, 2021 segment of “Show Me Today”.

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Brian Hauswirth

Brian Hauswirth began as Missourinet news director in July 2016. He anchors daily newscasts, simulcasts and special reports from the Missouri Capitol in Jefferson City, where he primarily covers the Missouri House and numerous legislative committee hearings.