, , ,

“Listen to the people” “Medicaid expansion is good for Missouri’s health” [July 1, 2021, Jefferson City, Missouri]


Crystal Quade @crystal_quade
My statement on the Supreme Court upholding the Medicaid expansion amendment:

Today’s unanimous Missouri Supreme Court decision is a complete vindication for those who have worked to expand health care access and a thorough rejection of those willing to defy Missouri voters
12:22 PM · Jul 22, 2021

Crystal Quade @crystal_quade
…and ignore the rule of law to stop it from happening. We expect the trial judge will follow the Supreme Court’s clear direction and promptly order the state to begin providing Medicaid services to the expanded population as mandated by the Missouri Constitution.

2/2 #MoLeg
12:22 PM · Jul 22, 2021

House Democratic Minority Leader Crystal Quade [2018 file photo].

In the Missouri Constitution:

IV Section 36(c). MO HealthNet expansion — eligibility — state plan amendments — maximization of federal participation — limitation on burdens or restrictions. — 1. Notwithstanding any provision of law to the contrary, beginning July 1, 2021, individuals nineteen years of age or older and under sixty-five years of age who qualify for MO HealthNet services under 42 U.S.C. Section 1396a(a)(10)(A)(i)(VIII) and as set forth in 42 C.F.R. 435.119, and who have income at or below one hundred thirty-three percent of the federal poverty level plus five percent of the applicable family size as determined under 42 U.S.C. Section 1396a(e)(14) and as set forth in 42 C.F.R. 435.603, shall be eligible for medical assistance under MO HealthNet and shall receive coverage for the health benefits service package.

  2. For purposes of this section “health benefits service package” shall mean benefits covered by the MO HealthNet program as determined by the department of social services to meet the benchmark or benchmark-equivalent coverage requirement under 42 U.S.C. Section 1396a(k)(1) and any implementing regulations.

  3. No later than March 1, 2021, the Department of Social Services and the MO HealthNet Division shall submit all state plan amendments necessary to implement this section to the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services.

  4. The Department of Social Services and the MO HealthNet Division shall take all actions necessary to maximize federal financial participation in funding medical assistance pursuant to this section.

  5. No greater or additional burdens or restrictions on eligibility or enrollment standards, methodologies, or practices shall be imposed on persons eligible for MO HealthNet services pursuant to this section than on any other population eligible for medical assistance.

  6. All references to federal or state statutes, regulations or rules in this section shall be to the version of those statutes, regulations or rules that existed on January 1, 2019.


(Adopted August 4, 2020)

Yesterday, from the Missouri Supreme Court:

en banc

STEPHANIE DOYLE, et al., Opinion issued July 22, 20212 No. SC99185



The Honorable Jon E. Beetem, Judge


Stephanie Doyle, Melinda Hille, and Autumn Stultz, three Missourians who are eligible for MO HealthNet coverage under article IV, section 36(c) of the Missouri Constitution, (“Plaintiffs”) brought suit challenging the refusal by the Department of Social Services (“DSS”) to provide that coverage because the General Assembly failed to appropriate adequate funding. The circuit court rejected Plaintiffs’ claims because it found the ballot initiative that enacted article IV, section 36(c) violated article III, section 51 of the Missouri Constitution, which prohibits initiatives from appropriating money without creating revenue to fund the initiative. Because article IV, section 36(c) does not appropriate money and does not remove the General Assembly’s discretion in appropriating money to MO HealthNet, the circuit court erred in declaring article IV, section 36(c) constitutionally invalid. The circuit court’s judgment is affirmed in part and vacated in part, and the cause remanded for the circuit court to enter judgment for the Plaintiffs, which includes determination of the appropriate injunctive relief.


Nothing in article IV, section 36(c) deprives the General Assembly of its discretion and requires it to appropriate a specified amount for MO HealthNet services and benefits. The General Assembly maintains the discretion to decide whether and to what extent it will appropriate money for MO HealthNet programs. 4 Even though it is highly possible the General Assembly appropriated less money than MO HealthNet programs are estimated to cost in FY 2022, the consequences of failing to fund MO HealthNet fully at the outset or even with a supplemental appropriation are not before this Court because they are not relevant to whether article IV, section 36(c) violates article III, section 51. Because article IV, section 36(c) does not expressly appropriate money for MO HealthNet nor deprive the General Assembly of discretion and require it to appropriate money for its purposes, it does not violate article III, section 51.


The General Assembly chose to appropriate funds for the MO HealthNet programs for FY 2022. This was one of presumably thousands of difficult decisions made each year during the appropriation process. But, having made this decision, DSS and MO HealthNet are bound by article IV, section 36(c) concerning which individuals are eligible to enroll when it spends the appropriated funds. Consequently, DSS has appropriation authority to provide services for all individuals eligible for MO HealthNet, including individuals eligible for coverage and services pursuant to article IV, section 36(c).


For the reasons set forth above, the circuit court’s judgment is affirmed only insofar as it overruled the Proposed Intervenors’ motion to intervene. In all other respects, the judgment is vacated, and the cause is remanded to the circuit court to enter judgment for the Plaintiffs, which includes determination of the appropriate injunctive relief.

All concur.

“All concur”.

“Medicaid expansion is the law of the land” [July 1, 2021, Jefferson City, Missouri]