Judge weighs allowing new plaintiffs to join Missouri Medicaid expansion lawsuit

Allowing new plaintiffs to join a lawsuit over whether Missouri must provide Medicaid coverage to an expanded population of low-income adults could delay resolution of the case beyond the July 1 start date for that coverage, attorneys told a Cole County judge on Monday morning.

A trial in the lawsuit is scheduled for Friday afternoon. Circuit Judge Jon Beetem did not rule at the end of a 25-minute hearing on the request from attorney Paul Martin of St. Louis to add two new plaintiffs, but the decision is expected quickly because of the tight schedule.

“Plaintiffs are opposed to intervention because we just lost our trial date,” said Chuck Hatfield, who is representing the original plaintiffs in the lawsuit filed May 20.

A delay would make it more difficult to have any appeal heard and decided by the Western District Court of Appeals prior to July 1, Hatfield said.

Martin, who said he could be ready for trial next week, said his clients have a right to intervene because the arguments raised by Hatfield and his co-counsel, Lowell Pearson, don’t cover every issue he wants the court to consider.

“I don’t see it as anything that is going to take a significant delay or prejudice anyone in a significant way,” Martin said.

If Beetem doesn’t agree that his clients have a right to intervene, Martin said, he could still allow the additional plaintiffs because they do not have adequate funds to file and litigate a separate lawsuit. They lack even the money for fees required to file a lawsuit, he said.

“If I don’t pay that for them, they will not have access to the court system,” Martin said.

John Sauer of the Attorney General’s Office, who is representing the state and arguing that the state is not obligated to provide coverage, said he is neutral on whether to allow Martin’s clients to join the case.

Any new filings in the case could be completed by June 23, Sauer said, and the state would be ready for trial after that date.

The case will determine whether Missouri will implement the provisions of a constitutional amendment, proposed by initiative petition and passed in August 2020, setting new eligibility requirements for Medicaid. Under the amendment, coverage would be provided to anyone ages 19 to 64 with a household below 138 percent of the federal poverty guideline, or $17,774 a year for a single person. For a household of four, the limit is $36,570.

Gov. Mike Parson, in his January budget proposal, asked lawmakers to add $1.9 billion to state spending, including $130 million from the general revenue fund, to pay the anticipated costs of adding about 275,000 people to Medicaid rolls. The General Assembly refused to include the money and on May 13, Parson announced he had withdrawn a revision to Missouri’s Medicaid plan describing the services to be provided. 

Hatfield and Pearson filed a lawsuit on behalf of three people who would be eligible for Medicaid coverage on July 1. They argue that the constitutional provisions setting eligibility are not dependent on an appropriation specifically for the newly eligible because the budget already funds all the services available under Medicaid.

Sauer argues that a constitutional limit on initiatives that require state appropriations means that a lack of specific funding makes the constitutional provision inoperative.

The plaintiffs Martin represents include a person who would become eligible on July 1 and another who is a current Medicaid recipient who would lose coverage when the COVID-19 pandemic emergency ends.

The arguments over the General Assembly’s decision not to fund Medicaid expansion are irrelevant to the lawsuit, Martin argued. Beetem should rule on whether Parson acted correctly by withdrawing plan amendments and whether the constitutional eligibility will be enforced.

The case before his clients intervened was too focused on funding, Martin said.

“The risk to the intervenors is huge if that perspective is promoted and in fact the plaintiffs lose the case,” Martin said.

Before passage of the initiative, known as Amendment 2, Missouri was one of 14 states that had not yet expanded Medicaid under the Affordable Care Act. The law originally made expansion mandatory but the U.S. Supreme Court ruled in 2012 that penalty provisions that made Medicaid an all-or-nothing program were unenforceable.

Adults who have no other qualifying condition such as a disability are only eligible currently if they have children and income lower than about $4,800 a year for a family of four. 

While Beetem did not indicate when he would rule, he said he understands the tight time constraints.

“I would rather have this done sooner than later,” Beetem said.