Oklahoma and the ACA’s Medicaid expansion

Medicaid expansion takes effect July 1, 2021, with enrollment starting June 1

Key takeaways

• An Oklahoma Medicaid expansion initiative was approved by voters in June 2020; expansion takes effect July 1, 2021 (enrollment begins June 1, 2021).
• Nearly 855k — mostly children — are enrolled in Medicaid in Oklahoma (about 8% higher than enrollment in 2013, with significant enrollment growth in 2020 2020 amid the COVID-19 pandemic)
• Gov. Stitt opposed straight Medicaid expansion, but had proposed SoonerCare 2.0: Expansion in July 2020, with various restrictions that would have taken effect a year later.
• But amid concerns over a sharply higher number of people who would be eligible due to job losses stemming from COVID-19, Stitt vetoed a bill designed to provide funding for SoonerCare 2.0 and the state withdrew the plan to expand coverage in July 2020.
• Oklahoma was seeking federal approval for a Medicaid work requirement that would have applied to 6,000 enrollees (but the Biden administration is not approving Medicaid work requirements).
• Oklahoma has the second-highest uninsured rate in the U.S., and 59% of the uninsured are in the Medicaid coverage gap
• Oklahoma’s GOP majority continues to reject federal funding to expand Medicaid, so voters took matters into their own hands and passed a ballot initiative to expand Medicaid.
• Medicaid expansion, as called for in the ACA, takes effect in July, with coverage newly available to non-elderly adults earning up to 138% of the poverty level.  
• Governor Stitt had proposed an alternative approach to Medicaid expansion — dubbed SoonerCare 2.0 — that would have eventually included premiums, a work requirement, and a per-capita spending cap.  But the future of SoonerCare 2.0 was upended after Governor Stitt unexpectedly vetoed a bill that would have provided funding for the program. Stitt had proposed the SoonerCare 2.0 program before the COVID-19 pandemic began, but noted that the widespread unemployment due to the pandemic has resulted in far more people who would be eligible for coverage under expanded Medicaid, at a financial cost that would be significantly higher than the state had initially projected. Once Stitt vetoed the funding bill, the state withdrew its expansion state plan amendment. A month later, voters in Oklahoma approved ballot Question 802, paving the way for full (no strings attached) Medicaid expansion to take effect in the state as of July 2021.

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