Missouri starts signing up residents under ACA's Medicaid expansion after legal fight

Residents eligible for expanded Medicaid in Missouri can now sign up for coverage more than a month after a federal judge demanded the state implement it.

The Centers for Medicare & Medicaid Services (CMS) announced Monday that 275,000 residents in the state are eligible for coverage under the expansion. Missouri becomes the 38th state to expand coverage under the Affordable Care Act. The District of Columbia also expanded its Medicaid program.

“We will continue to encourage remaining states to extend the lifeline of Medicaid coverage to all who need it,” said CMS Administrator Chiquita Brooks-LaSure in a statement.

The expansion of Medicaid comes after a major legal fight over how to implement it.

Voters in the state approved expansion as part of a ballot measure in August 2020. But the state’s legislature and Republican Gov. Mike Parsons refused to implement it after the legislature did not appropriate funding.

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This triggered a lawsuit from three residents that charged the state was required to expand Medicaid after the ballot initiative.

A state circuit court ruled in June that the ballot initiative was unconstitutional because it did not specifically create an appropriation of revenue for the expansion.

But the state’s Supreme Court ruled in July that the ballot measure didn’t get rid of the legislature’s ability to approve funds for the Medicaid program. The court ruled the state still had to sign up residents eligible for the expansion.

CMS noted in its release Monday that Missouri is now eligible for a five-percentage point increase in its federal matching rate for two years. The American Rescue Plan Act included the enhanced matching rate for states that newly expanded to entice holdouts.

But, so far, no other states have signed up to take advantage of the temporary boost.

Democrats in Congress are hoping to close the Medicaid coverage gap as part of a $3.5 trillion infrastructure package being debated now. Some Democrats have endorsed the creation of a program resembling Medicaid that would extend coverage to eligible residents in non-expansion states.