Did the Missouri AG approve the ballot summary for the 2020 Medicaid expansion initiative petition?

Plain-English summary

Missouri Attorney General Eric Schmitt approved the legal content and form of the Secretary of State's summary statement for the Heidi Miller initiative petition, designated 2020-053. The petition proposed to amend Chapter 208 of the Revised Statutes of Missouri to adopt the Medicaid Expansion population under the Affordable Care Act, covering adults ages 19 to 64 whose income is at or below 133% of the federal poverty level. The summary statement also flagged two operational rules in the petition: a prohibition on imposing greater eligibility or enrollment burdens on the expansion population than on other Medicaid populations, and a requirement that state agencies take all actions needed to maximize federal financial participation in funding the expansion.

This is the procedural step in § 116.334, RSMo, that lets the petition move forward in the initiative process. The AG's review goes only to legal content and form, not to the policy merits of expanding Medicaid.

This petition was part of the wave of citizen-led Medicaid expansion efforts that reached Missouri voters in 2020 as Amendment 2.

Currency note

This opinion was issued in 2019. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

What is Medicaid Expansion?

Under the Affordable Care Act (42 U.S.C. § 1396a(a)(10)(A)(i)(VIII)), states may extend Medicaid eligibility to non-elderly adults whose household income is at or below 133% of the federal poverty level. The federal government pays a large share of the cost of the expansion population. Whether to take up the expansion is a state choice, and Missouri had not yet done so at the time of this petition.

What does the 133% federal poverty level threshold mean in practice?

The exact dollar figure varies with household size and changes annually. As a rough benchmark in 2019, 133% of the federal poverty level was approximately $16,600 in annual income for a single adult, or roughly $33,800 for a family of four. Current figures should be checked at the HHS poverty-guidelines page rather than relying on a 2019-era estimate.

Why does the summary mention "maximizing federal financial participation"?

Federal Medicaid funding flows as a "match" against state spending. For the expansion population, the federal match started at 100% and stepped down to 90% under the ACA. The petition language directed state agencies to take whatever steps were needed to capture the maximum federal share.

Did this petition reach the ballot?

Yes, ultimately. Missouri voters approved Medicaid expansion in August 2020 as Amendment 2. Whether this specific petition number (2020-053) is the one that made the ballot, or whether a parallel petition number from the same year-of-circulation cycle is, can be verified by the Secretary of State's archived records.

Why is the petition number "2020-XXX" if the opinion is from 2019?

Missouri's initiative numbering uses the target election year, not the year of submission. Proponents circulate petitions in the year before the election they target, so 2019-issued petitions for the 2020 ballot carry "2020-NNN" identifiers.

Background and statutory framework

§ 116.334, RSMo, is the AG's review step in the petition-summary process. Once approved (or after any required revisions), the summary statement is what appears on circulator petition sheets and, ultimately, the basis for the ballot title that voters see. The underlying constitutional and statutory framework for citizen initiatives in Missouri is found in Mo. Const. art. III, §§ 49 to 53, and in Chapter 116, RSMo.

Citations

• § 116.334, RSMo (AG review of initiative summary statements)
• Chapter 208, Revised Statutes of Missouri (statutes the petition proposed to amend)
• Initiative Petition 2020-053 (Miller)
• Patient Protection and Affordable Care Act, 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII) (Medicaid expansion population)

Source

• Landing page: https://ago.mo.gov/other-resources/ag-opinions/
• Original PDF: https://ago.mo.gov/wp-content/uploads/attachments/79-2019.pdf?sfvrsn=2

Original opinion text

ATTORNEY GENERAL OF MISSOURI
ERIC SCHMITT

May 2, 2019
OPINION LETTER NO. 79-2019

The Honorable John R. Ashcroft
Missouri Secretary of State
James C. Kirkpatrick State Information Center
600 West Main Street
Jefferson City, MO 65101

Dear Secretary Ashcroft:

This opinion letter responds to your request dated April 22, 2019, for our review under § 116.334, RSMo, of a proposed summary statement prepared for the petition submitted by Heidi Miller regarding a proposed amendment to amend Chapter 208, Revised Statutes of Missouri (2020-053). The proposed summary statement is as follows:

Do you want to amend Missouri law to:

• adopt Medicaid Expansion for persons 19 to 64 years old with an income level at or below 133% of the federal poverty level, as set forth in the Affordable Care Act;

• prohibit placing greater or additional burdens on eligibility or enrollment standards, methodologies or practices on persons covered under Medicaid Expansion than on any other population eligible for Medicaid; and

• require state agencies to take all actions necessary to maximize federal financial participation in funding medical assistance under Medicaid Expansion?

Pursuant to § 116.334, RSMo, we approve the legal content and form of the proposed statement. Because our review of the statement is mandated by statute, no action that we take with respect to such review should be construed as an endorsement of the petition, nor as the expression of any view regarding the objectives of its proponents.

Very truly yours,

ERIC S. SCHMITT
Attorney General

Broadway Building
P.O. Box 899
Jefferson City, MO 65102
Phone: (573) 751-3321
Fax: (573) 751-0774
www.ago.mo.gov

OP-2019-0085