Appeals court keeps Medicaid expansion on August ballot

The Missouri Court of Appeals Western District ruled today that a ballot measure proposing to expand Missouri’s Medicaid system can stay on the Aug. 4 ballot.

Ryan Johnson, a senior advisor to the group United for Missouri, and Jeremy Cady, the director of the Missouri chapter of Americans for Prosperity, had filed similar but separate challenges to the ballot measure. They argued that the measure violates a state constitutional provision prohibiting initiative petitions from being used to appropriate money without providing a funding mechanism.

The proposal would expand Medicaid eligibility to adults earning up to 138 percent of the federal poverty level. Under the Affordable Care Act, the state could recover 90 percent of the cost of that expansion from the federal government. But the challengers said the state still would have to cover 10 percent of the $2 billion per year expansion.

Under Article III, section 51 of the Missouri Constitution, the initiative process “shall not be used for the appropriation of money other than of new revenues created and provided for thereby, or for any other purpose prohibited by this constitution.”

In a 15-page ruling issued just hours after oral arguments, the Western District said the Medicaid proposal didn’t run afoul of that constitutional requirement and shouldn’t be stricken from the ballot.

“The forecasts as to costs of the Proposed Measure go to what the Proposed Measure will or may do if approved by the voters and put into operation, not to whether the Proposed Measure is properly put before the voters,” Judge Mark D. Pfeiffer wrote. “Funding for the Missouri Medicaid program, MO HealthNet, is appropriated annually by the General Assembly. The Measure does not direct or restrict the General Assembly’s ability to change the amount of appropriations for the MO HealthNet program or to increase or decrease funding for the program based on health-care-related costs.”

Judges Anthony Rex Gabbert and W. Douglas Thomson concurred.

The case is Cady and Johnson v. Ashcroft, WD83823.