The Missouri Department of Social Services submitted a letter to the Centers for Medicare and Medicaid Services formally withdrawing its State Plan Amendments for MO HealthNet expansion.
On August 4, 2020, Missouri voters approved a constitutional amendment expanding MO HealthNet eligibility to individuals between 100 and 138 percent of the federal poverty level. However, the Missouri Constitution prohibits ballot initiatives from appropriating funds without creating a revenue source.
“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,” Governor Mike Parson said. “However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri’s existing MO HealthNet program remains solvent.”
Prior to the August 4 vote, the Missouri Court of Appeals Western District issued an opinion in June 2020, explicitly stating that the MO HealthNet expansion ballot initiative did not create a revenue source or direct the General Assembly to appropriate funds. The court noted that the General Assembly retained discretionary authority to fund or not fund MO HealthNet expansion if the ballot initiative passed.
Soon after the ballot initiative was approved by voters, DSS began laying the groundwork for expansion in anticipation of the General Assembly appropriating funding. DSS estimated that it would cost Missouri approximately $1.9 billion to fund the expansion in FY2022, and Governor Parson included the suggested funds in his annual budget proposal to the General Assembly.
On May 7, 2021, the General Assembly finalized the state’s FY2022 budget without funding for MO HealthNet expansion or appropriation authority to DSS or the Office of the Governor. Since the ballot initiative was not self-funding and the General Assembly declined to appropriate funds, the executive branch lacks authority to proceed with MO HealthNet expansion at this time.
Without the necessary funds, DSS must withdraw the SPAs previously submitted to CMS to prevent more Missourians from becoming eligible for MO HealthNet than the state program has funds to cover.
To view the letter from DSS that was sent to CMS, please click here.