JEFFERSON CITY, Mo. — The Missouri Department of Social Services must allow newly eligible residents who qualify for benefits under voter-approved Medicaid expansion to enroll and cannot impose greater restrictions on them, a Cole County judge ruled Tuesday.

Cole County Circuit Court Judge Jon Beetem sided with the plaintiffs who urged him to allow Medicaid expansion to take effect as soon as possible rather than allow the state to make its case for why it needs two more months to begin accepting newly eligible residents.

Attorney Chuck Hatfield, who represented the plaintiffs challenging the state, said it’s time to stop talking about implementing Medicaid expansion and start doing it.

“It’s great that the courts have — today, on the 200th anniversary of Missouri — enforced that will, and said, ‘Yeah, you actually have to do what the people voted for,’” Hatfield said. “That’s how this is supposed to work, and it’s a good day.”

Nina Canaleo, a 38-year-old Kansas City resident who receives no health insurance through her part-time job cleaning a grocery store at night, said it’s time.

“This time they finally have to abide by something that we all voted on and then it passed,” Canaleo said. “Stop dragging their feet.”

For Canaleo, the roughly $14,000 she makes a year isn’t enough to sufficiently treat her multiple sclerosis, a chronic nerve disease that leaves her with numb and swollen feet. She was only able to purchase health insurance this year after a fundraiser helped her cover the costs. Tuesday’s decision helps relieve the stress of knowing Medicaid will be an option when that runs out.

“Every day my illness just gets worse. and just to subside that a little bit is great,” Canaleo said, adding: “If I can get all the medical, I can get to where I can go to work. That’d be great. I’m not ready to stop working.”

A spokesman for Missouri Attorney General Eric Schmitt declined to comment on Tuesday’s ruling. The governor’s office and the Department of Social Services did not immediately respond to requests for comment.

“I haven’t seen the entire ruling, but let me say this: I’m going to follow the law. I’ve always done that and always will continue to do that,” Gov. Mike Parson said Tuesday, according to the St. Louis Post-Dispatch.

The Missouri attorney general’s office argued last week that while implementation was underway, it would be difficult to immediately begin carrying out Medicaid expansion and said computer systems and personnel still needed to be put in place. John Sauer, the solicitor general of Missouri, requested Beetem grant another hearing for witnesses from MO HealthNet and the Family Support Division within the Department of Social Services to testify to that point.

However, attorneys who represent three women who would have qualified for coverage under the expanded Medicaid program that voters approved in August 2020 said doing so would continue to allow the state to violate the law.

“‘Don’t deny,’ that’s what we’re asking you to tell them,” Hatfield told Beetem last week. “Don’t deny.”

A spokeswoman for the Department of Social Services did not immediately respond to a request for comment last week on whether the department has paused processing or denied new applications it has received since July 1 from newly eligible residents who qualify under Medicaid expansion.

Supreme Court ruling

Last month, the Missouri Supreme Court overturned Beetem’s earlier ruling, unanimously ordering Missouri to expand Medicaid to the approximately 275,000 residents who became eligible when it would have gone into effect July 1.

By allocating funds for the Medicaid program, the state must allow all eligible to access those benefits and cannot differentiate between eligible populations, like those who previously qualified versus those newly eligible.

Under the constitutional amendment passed last year, 19- to 64-year-old adults whose household incomes are 138% of the federal poverty guideline or less would qualify for benefits under Missouri’s Medicaid program. That ends up being $17,774 a year for a single person and $36,570 for a family of four.

Despite the amendment passing with 53.3% of the vote, lawmakers refused to appropriate the $1.9 billion in state and federal funds needed to finance Medicaid expansion. In May, the state ultimately withdrew a plan it had submitted to federal regulators as a result.

Part of the plaintiffs’ request was that Beetem order the state to submit a new state plan amendment; attorneys for the state have indicated the Department of Social Services plans to do so and apply it retroactively to July 1, the date Medicaid expansion would have gone into effect.

Parson said his administration is making plans to move forward, in addition to preparing to resubmit a state plan amendment to the federal government, “but we really cannot until we find out: do we have the ability to do that,” Parson told St. Louis Public Radio’s “Politically Speaking” last week.

“What I really don’t want is some judge deciding for us how we’re going to implement this from an area he has no experience in,” Parson said. “And the other thing, if we do have to implement — if we do — I don’t want to be in a position where we lose the 90% match from the federal government. and that’s a reality.”

Under the Affordable Care Act, states pay 10% of the costs of newly eligible Medicaid participants, with the federal government matching the remaining 90%.

Parson said he will not call a special session to allocate additional funding unless there’s a plan in place. He also said he does not want a repeat of cuts to Missouri’s Medicaid rolls that then-Gov. Matt Blunt pushed in 2005, which ended up booting tens of thousands of people off Medicaid who had already signed up.

But Parson said if there is no additional funding appropriated to fund Medicaid expansion, it could be a reality.

“And in this particular instance it’s even worse, because now you’re talking about able-bodied adults,” Parson told St. Louis Public Radio. “And are you going to take somebody that’s disabled off the system? Are you going to take somebody else that has health issues off of that for an able-bodied adult? I don’t think anybody wants that.”

Hatfield said he hopes there’s no need for any additional legal action and that implementation will go smoothly, knowing it will take some time to process new applications.

Shortly after Tuesday’s order was released, Missouri Jobs With Justice, an advocacy organization that was part of the coalition that campaigned for expansion’s passage, urged residents with questions about whether they qualify for coverage to call a hotline to get answers.

Senate Minority Leader John Rizzo, D-Independence, celebrated Beetem’s ruling as the culmination of a long push to expand health care coverage in Missouri.

“The latest Republican attempt to block and delay Medicaid expansion has failed,” he tweeted shortly after the ruling was issued. “The state must begin enrolling eligible (people) and they must begin now. Let’s be clear: Health care for working families is a good thing. Glad to see Eric Schmitt’s losing streak continue.”

Missouri Independent is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a public charity. It can be found at

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