(CNN)The battle to expand Medicaid in Missouri has now shifted to the courtroom.
A lawsuit was filed Thursday to force GOP Gov. Mike Parson to expand Medicaid on July 1, as voters approved in a ballot measure last year. The move comes a week after Parson said he will not broaden the public health insurance program to roughly 275,000 low-income residents because lawmakers did not appropriate funding.
The suit, filed on behalf of three Missourians with chronic health conditions who cannot afford coverage or treatment, argues that the state's Medicaid program has been funded by the General Assembly and that lawmakers do not need to set aside specific money for expansion enrollees.
It also notes that Congress' recent $1.9 trillion relief bill offers additional federal support to states that expand Medicaid, which would provide Missouri with more than $1 billion in extra money that would cover the state's share of expansion for five years.
Filed by a consumer legal advocacy group and two staffers of former Democratic and Republican state officials, the suit seeks to require the Department of Social Services to allow low-income residents to enroll in Medicaid starting July 1.
Democratic state officials and consumer advocates signaled last week that a lawsuit would be coming after Parson sent a letter to the federal Centers for Medicare and Medicaid Services withdrawing the state's expansion plan, saying Missouri will resubmit it should funding circumstances change.
"Although I was never in support of MO HealthNet expansion, I always said that I would uphold the ballot amendment if passed," the governor said. "However, without a revenue source or funding authority from the General Assembly, we are unable to proceed with the expansion at this time and must withdraw our State Plan Amendments to ensure Missouri's existing MO HealthNet program remains solvent."
Expanding at the ballot box
Missouri became the sixth state to approve Medicaid expansion at the ballot box last August when voters supported it by 53% to 47%. In Oklahoma, where voters narrowly approved expansion last June, newly eligible residents can start applying for coverage on June 1. It takes effect the following month.
Expanding Medicaid in Missouri would cost the state $130 million annually, said Amy Blouin, CEO of the left-leaning Missouri Budget Project. The federal government, which covers 90% of the cost, would provide the state with $1.7 billion a year.
"Missouri legislators funded Medicaid in the state budget, and it's clear that implementation can proceed for July 1st as planned," she said.
A Kaiser Family Foundation review of research found that expansion can result in state budget savings by offsetting costs in other areas, reduced uncompensated care costs for hospitals and clinics, and gains in employment.
Other than Missouri and Oklahoma, another 12 states have yet to expand Medicaid. All have Republican governors or GOP-controlled legislatures.
More than 2 million uninsured adults fall into the "coverage gap," meaning their incomes were too high to qualify in their states but too low to make them eligible for Affordable Care Act premium subsidies, which are open only to those earning more than 100% of the poverty level in non-expansion states.
