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Missouri Legislature Passes $35 Billion Budget Without Medicaid Expansion

Missouri House Speaker Rob Vescovo (left) and Speaker Pro Tem John Wieman (right) address the media after the legislature approved a $35 billion budget that does not include funding for Medicaid expansion.
Jonathan Ahl
St. Louis Public Radio
Missouri House Speaker Rob Vescovo (left) and Speaker Pro Tem John Wieman address the media Friday after the legislature approved a $35 billion budget that does not include funding for Medicaid expansion.

JEFFERSON CITY — The Republican-controlled Missouri legislature passed a $35 billion spending plan on Friday afternoon without including funding to expand Medicaid.

A 2020 constitutional amendment voters passed would add 275,000 low-income Missourians to the health care plan, with the federal government picking up 90% of the cost. But lawmakers declined to put the $130 million in the budget that would have paid the state’s share, saying the amendment didn’t specify funding.

Now it’s unclear if the state will enroll the newly eligible people starting on July 1, as the constitutional amendment directs.

“In my mind, there is not a need to enroll that population if there is no money to provide benefits to them,” said Cody Smith, R-Carthage, chairman of the House Budget Committee. “It could be a matter of a technical disagreement. Do we enroll those folks but then don’t provide benefits? What I do know is that there is no money in this budget for Medicaid expansion.”

Democrats say the constitution is clear, and newly eligible people will be able to sign up. And the state’s budget now means that all Medicaid recipients, not just the newly eligible ones, will have their benefits at risk.

“We underfunded all of Medicaid,” said Peter Merideth, D-St. Louis. “I don’t believe that’s the intention, but that’s what the constitution says we just did. The governor knows that, the department knows that. They're going to have to go forward, because they follow the law.”

The matter may get some clarity from Gov. Mike Parson, as he can direct the state to allow new people to sign up. Parson opposed Medicaid expansion but put funding for it in his proposed budget, citing the approval by voters.

The matter will likely be decided in court, as Medicaid expansion advocates are already saying they'll sue the state.

The budget includes more money for public defenders, a pay raise for state workers and money to cover unemployment benefits that were mistakenly given to some people during the coronavirus pandemic.

The budget also includes an increase of 3.7% for higher education institutions. That money is not enough, said Sen. Greg Razer, D-Kansas City.

Razer said that even with this increase, cuts over the past 20 years have left state universities with the same amount of money they received in 2001.

“We need to make sure we have the best faculty and attract the best students, and I hope the trend that we see this year is not an anomaly,” Razer said.

While both chambers passed the budget, next year’s financial picture is not fully resolved. The state still needs to allocate billions of dollars in federal stimulus money that will be arriving in the coming months. That will likely be addressed during a special session over the summer.

And an increase in the gas tax might also come up for a vote in the final week of this session, which starts on Monday.

House Speaker Rob Vescovo, R-Arnold, is noncommittal on its chances.

“A week is a long time in this building. There are a lot of things left,” Vescovo said. “There are members who would like to see the gas tax come to a vote. It’s important to some members. We will see how that rolls out.”

Follow Jonathan on Twitter: @JonathanAhl

Jonathan Ahl is the Newscast Editor and Rolla correspondent at St. Louis Public Radio.