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(The Center Square) – Cole County Circuit Judge Jon Beetem said he will issue a ruling in a "day or two,” no later than Wednesday, in a lawsuit challenging the Legislature’s decision not to fund Medicaid expansion in the state.

Beetem heard arguments Monday afternoon during a relatively brief hearing from state attorneys and lawyers representing three Missouri women who say they would have been among 275,000 low-income adults eligible for “life and death” Medicaid services under expansion, which was approved narrowly by voters last year.

The case heard in Beetem’s 19th Judicial Circuit Court courtroom in Jefferson City is being closely watched nationally and is certain to land before the Missouri Supreme Court and, potentially, the nation’s highest court.

Amendment 2 was adopted by 53% of voters in August but the Legislature approved, and Gov. Mike Parson signed, a $35 billion Fiscal Year 2022 budget without the funding for the expansion.

Parson had requested a $130 million state match to draw $1.2 billion in federal taxpayer dollars to provide 275,000 low-income Missouri adults Medicaid coverage under Amendment 2, but lawmakers opted not to fund expansion.

Stephanie Doyle, Melinda Hille and Autumn Stultz filed the lawsuit May 20 against the state for denying them access to the Medicaid health care services they’d have been eligible for after July 1.

In pre-trial filings, Missouri Assistant Attorney General John Sauer argued Medicaid expansion required lawmakers to “hide elephants in mouseholes” to pay for the expansion.

Sauer said lawmakers had discretion in funding Medicaid expansion, regardless of voters’ approval of Amendment 2, because the Missouri Constitution requires initiatives that cost money also provide a corresponding revenue source. Amendment 2 doesn’t do that.

“Key legislators on both sides of the issue understood the Legislature had not funded the expansion, and the governor, sharing that understanding, withdrew the state plan amendments for Medicaid expansion,” Sauer wrote.

He contends the lawsuit asks Beetem to rule that because appropriation bills do not prohibit spending money on Medicaid expansion, the state is required to do so.

“Only the clever plaintiff’s attorneys in this case grasped the secret meaning of (the appropriations bill) – that it had, against everyone’s reasonable expectations, actually funded Medicaid expansion,” Sauer wrote.

Hatfield and co-counsel Lowell Pearson contend there is no “secret meaning.” Beetem need only read “the plain language” of appropriation bills to order the state to do as the people told it to when they adopted Amendment 2, they say.

“The constitution’s repeated use of the term ‘shall,” they write in their pre-filing, “makes clear that defendants have no discretion to deny coverage to an eligible individual.”

Hatfield and Pearson maintain the actual costs of Medicaid programs are never known when lawmakers approve a state budget. Supplemental bills — such as this year’s $500 million state Medicaid boost — are evidence of that, they argue.

Sauer told Beetem a "reasonable reader" of appropriations bills would see the state’s Department of Social Services, Department of Health & Human Services and Office of Administration have no money budgeted for expansion.

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