Health Center State Policy

Medicaid Expansion: Victory in Oklahoma and The Future Ahead

Source: Kaiser Family Foundation

Oklahoma voters have approved expanding Medicaid, narrowly passing a ballot initiative 50.48% to 49.52%, a margin of just 6,488 votes. Although four other states have expanded Medicaid via a ballot initiative, Oklahoma is the first to enshrine the expansion as a state constitutional amendment, making it exceedingly difficult for it to be rolled back; to do so would require another constitutional amendment approved by voters. Oklahoma’s constitution will also include language reading, “no greater or additional burdens or restrictions on eligibility or enrollment shall be imposed on persons eligible for medical assistance pursuant to this Article than on any other population eligible for medical assistance.” This makes it challenging, if not impossible, for state policymakers to implement work requirements, premiums or other eligibility or enrollment restrictions that can pose a hardship on expansion populations.

Oklahoma’s journey to expanding Medicaid has been arduous. Advocates have pushed for expansion since the Affordable Care Act was passed in 2010, but it was only in January 2020, when Seema Verma, Administrator of the Center for Medicare and Medicaid Services, released the Healthy Adult Opportunity (HAO) waiver to block grant Medicaid, that Governor Kevin Stitt decided to act and expand the program. Stitt began pushing a plan to fund the expansion with a hospital tax back in March, only to veto the narrowly passed legislation in May because of concerns that the coronavirus pandemic would result in a drastic increase of Medicaid enrollees. Now that Medicaid expansion is protected in the state constitution, it supersedes the HAO waiver, making it virtually impossible for the Medicaid waiver to be successfully implemented.

This victory will bring enormous benefits to low-income adults in Oklahoma. It is estimated that 215,000 Oklahomans ages 18 – 65 years who earn up to 138% of the federal poverty level will qualify for coverage. While the expansion must begin by July 1, 2021, the process can move faster – Virginia expanded Medicaid six months after it became law and Louisiana took less than five months. Advocates also hope the expansion will help support already struggling rural hospitals. Oklahoma has seen half a dozen closures of rural hospitals since 2016, and an additional eight have declared bankruptcy. The Oklahoma Hospital Association and the State Medical Association both supported the expansion ballot initiative in part to help save these critical care access points.

With Oklahoma’s expansion victory, there are now 13 remaining states that have not expanded Medicaid. Missouri may very well be the next, with an expansion via a constitutional amendment on the ballot on their August 4th election. Successful expansion of Medicaid in Missouri and the other remaining states will go a long way towards closing the coverage gap for many vulnerable citizens. KFF has estimated that if the 14 remaining states (including Oklahoma) expanded Medicaid, an additional 4.7 million adults could become insured. Beyond just coverage, Medicaid expansion also has a meaningful impact on long-term health. Studies show that states that expanded Medicaid have more preventative cancer screenings and more cancers found at an earlier stage, a decrease in positive depression screenings, and an increase in prescription drug fulfillment for chronic conditions. Furthermore, states that expanded Medicaid saved the lives of at least 19,200 adults, while states that haven’t had at least 15,600 premature adult deaths. At a time when a national pandemic is causing skyrocketing unemployment and uninsured rates, Medicaid expansions are helping people access care they need.

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