On May 22, 2020, the Missouri Secretary of State issued a statement certifying the Missouri Medicaid Expansion Initiative for the ballot. This qualified the initiative for the November ballot unless the governor called for it to go on the August ballot by the May 26 deadline. On May 26, Governor Mike Parson (R) announced that the amendment will appear on the August 4 primary election ballot.
The initiative would amend the state constitution to do the following:
- expand Medicaid eligibility in Missouri to adults who are between the ages of 19 and 65 and whose income is at or below 133% of the federal poverty level, which would effectively expand Medicaid to those with incomes at or below 138% of the federal poverty level under the Affordable Care Act;
- prohibit any additional restrictions or requirements for the expanded population to qualify for Medicaid coverage than for other populations that qualify for Medicaid coverage; and
- require the state to seek maximum federal funding of Medicaid expansion.
In Missouri, the number of signatures required to qualify an initiated constitutional amendment for the ballot is equal to 8% of the votes cast for governor in the previous gubernatorial election in six of the eight state congressional districts. Healthcare for Missouri submitted 341,440 signatures to the Missouri Secretary of State on May 1, 2020. The secretary of state used a random sample method, which projected enough valid signatures in congressional districts 1, 2, 3, 5, 6, and 7, to qualify the measure for the ballot. In those six districts, a total of 172,015 valid signatures were required; 258,686 signatures were projected to be valid.
Medicaid is a government program that provides medical insurance to groups of people with income below certain levels and individuals with disabilities. The Affordable Care Act (ACA), also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138% of the federal poverty level. In 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that the federal government could not withhold funds from states that refused to expand Medicaid. The ruling had the practical effect of making Medicaid expansion optional for states. In 2018, the federal government financed 94% of the costs of state Medicaid expansion. For 2020 and subsequent years, the federal government was set to cover 90% of the costs.
As of 2019, a total of 36 states and Washington, D.C., had expanded or voted to expand Medicaid, while 14 states had not.
In 2017, voters in Maine approved a ballot initiative to expand Medicaid. The measure was the first time a citizen initiative to expand Medicaid appeared on any statewide ballot.