The Missouri Supreme Court has ruled that the state must expand Medicaid, becoming the 38th state to implement the Affordable Care Act’s provision to increase insurance coverage for the poor. The decision ends 15 years of acrimonious debate in the state on whether or not Medicaid should be expanded.

Medicaid will now be available to adults 19 years or older whose income is 138% of the federal poverty level or below under the ACA, better known as Obamacare.

Missouri voters passed a ballot question last year supporting the expansion, but Missouri Gov. Mike Parson (R) refused to do so after Republicans in the state legislature did not provide the funds for it.

A lower court ruled against the expansion in June stating that it was unconstitutional to pass the expansion because it required an appropriation of money without providing the revenue source.

The state Supreme Court ruled that the ballot measure in no way infringed on the legislature’s appropriation power.

Over 275,000 people in the state could gain coverage under Medicaid’s expansion eligibility. Obamacare originally mandated that states expand Medicare, but the U.S. Supreme Court ruled that each state can decide whether or not to opt into the program.

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