A trial to determine whether Missouri must expand Medicaid coverage as mandated by a 2020 initiative will take place Friday as scheduled, Cole County Circuit Judge Jon Beetem ruled Tuesday.
The ruling against adding new plaintiffs to the case came a day after Beetem heard arguments over whether two people who would become eligible for Medicaid on July 1 should be allowed to intervene. In the order distributed to attorneys Tuesday morning, Beetem wrote that the interests of the intervenors "will be adequately represented by the (original) Plaintiffs."
With the July 1 implementation date looming, "the delays inherent in adding another party will prejudice the original parties," Beetem wrote.
Under the terms of Amendment 2 passed in August 2020, Missourians aged 19-64 would be eligible for health coverage under Medicaid if their incomes are below 138 percent of the federal poverty guideline. But lawmakers rejected the proposed $1.9 billion to pay the costs of coverage and Gov. Mike Parson withdrew state plan amendments detailing services that would be provided.
Approximately 275,000 people would be eligible for coverage. The lawsuit was filed on behalf of three people who would be eligible July 1 and seeks an order for the Department of Social Services to allow them to enroll and receive the same coverage as current program clients.
Attorney Paul Martin of St. Louis had sought to add two additional plaintiffs in order to make arguments that he believes are being missed by attorneys Chuck Hatfield and Lowell Pearson, who filed the original lawsuit.
The state is arguing that lawmakers had discretion in funding the expanded coverage because the Missouri Constitution prohibits initiatives that appropriate existing state funds. Hatfield and Pearson are arguing that while lawmakers have discretion over how much to spend on Medicaid, the expansion group is eligible for coverage as long as the state has a Medicaid program.
During the Monday hearing on the motion to intervene, Hatfield reminded Beetem that the goal is to get the case resolved before July 1. Adding parties could cloud the issues the courts must decide and create delays, he said.
"We are still hoping to get a trip to the Court of Appeals to hopefully get all this decided by July 1," Hatfield told Beetem.
PREVIOUS COVERAGE (posted 12:10 a.m. June 15, 2021):
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 Monday.
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 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 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 Missouri Attorney General's Office, who is representing the state and arguing 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 19-64 with a household income 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 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 a constitutional limit on initiatives that require state appropriations means a lack of specific funding makes the constitutional provision inoperative.
The plaintiffs Martin represents include a person who would become eligible 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 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.
The Missouri Independent is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.