Missouri pulls application to expand Medicaid after state declines to fund it

A road sign reading "Missouri welcomes you"
Missouri will not expand Medicaid under the Affordable Care Act after its state legislature declined to appropriate funding for it. (marekuliasz/Getty)

Missouri has pulled its plans to expand Medicaid after the state’s legislature declined to fund the expansion, which voters called for in a ballot initiative last August.

Missouri’s Department of Social Services on Thursday asked the Centers for Medicare & Medicaid Services to withdraw its application to expand Medicaid under the Affordable Care Act (ACA).

“Without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time,” said Gov. Mike Parson in a statement Thursday.

The decision is a major setback for advocates who have been organizing ballot initiatives to expand Medicaid in holdout states. So far, there are 10 states that have not expanded under the ACA including Missouri. Oklahoma voters passed a similar ballot initiative to expand, but it has not been implemented yet, according to data from the Kaiser Family Foundation.

Missouri voters approved a constitutional amendment to expand Medicaid back in August 2020, but the state’s legislature refused to appropriate funds for it. The state’s constitution prohibits ballot measures from appropriating funds without any revenue source.

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The state’s court of appeals ruled in June of last year that the ballot initiative didn’t create a revenue source or direct the legislature to appropriate funding.

Parson included $1.9 billion for funding the expansion in his annual budget proposal, but the legislature finalized the state’s budget on May 7 without the funds, according to a release from the governor’s office.

Missouri is the latest state that advocates have targeted to expand Medicaid via ballot measures. An initiative in South Dakota has until November to gather signatures for a 2022 measure, and Mississippi is also working to gather signatures by September 2022 for a similar measure, Kaiser said.

The roadblock in Missouri also comes as the Biden administration has sought to sweeten funding to expansion holdouts. The American Rescue Plan Act included funding that increases federal matching Medicaid funds for two years to states that newly expand.