Oklahoma health care leaders have expressed concerns, saying expansion is a worthy investment.
Stitt said this question would help protect the state/federal program that covers medical services for low-income individuals “for those who really need it, not those who should be working.” He did not elaborate on what that could entail.
In 10 years, Stitt said Medicaid is projected to absorb 37% of the state’s annual budget, at $6 billion. He said he will do what he can within his authority to address welfare spending, referencing a recent executive order requiring state agencies to conduct a review of the federal welfare programs they administer.
The goal is to identify and address disincentives to work, crack down on fraud and errors, and seek waivers that “reduce bureaucratic overhead” in programs like Oklahoma Medicaid. Advocates have expressed concerns, saying this effort doesn't fully address the needs of people relying on food and medical assistance.
But Stitt said he needs the legislature’s help to make further changes to the program. Oklahoma is one of three states that enshrined expansion in its constitution, meaning an amendment is required to make changes.
“I always say government programs should be a trampoline, not a hammock, but too often that is not the case,” Stitt said.
What do health care leaders have to say?
On June 30, 2020, voters approved State Question 802 to expand Medicaid eligibility to adults aged 19-64 with income up to 138% of the federal poverty level. It went into effect the following year.
For this expansion population, the federal share of Medicaid is 90%, and the state contributes 10%.
Oklahoma expansion adults make up about 22% of total Medicaid enrollment, at 220,665 individuals. Following Medicaid expansion, Oklahoma’s uninsured rate has declined from 17.6% in 2019 to 13.9 % in 2024, according to U.S. Census Bureau estimates.
Rich Rasmussen, president and CEO of the Oklahoma Hospital Association, said in a statement that the goal of expansion was to improve health outcomes and expand access to care. He said Oklahoma’s national health ranking and maternal morbidity outcomes have improved, reflecting the service of hospitals and health care providers.
“The governor’s comments today are short on details, and we believe that the state legislature and President Trump have already given the state the tools to adjust the program, including work requirements,” Rasmussen said. “Medicaid expansion is a cost-efficient system largely funded by hospitals, not taxpayers, and limiting it would undermine care for all Oklahomans.”
Stitt’s ask comes as states prepare for billions of dollars in federal Medicaid spending reductions over a decade, which were signed into law in President Donald Trump’s massive spending and tax bill. The Oklahoma Hospital Association has projected a $6.7 billion impact on state hospitals over 10 years.
That legislation also included work requirements of 80 hours per month for the expansion population, with certain mandatory exemptions. The implementation deadline is the end of the year.
Dr. Sumit Nanda, president of the Oklahoma State Medical Association, said Medicaid is an investment that helps support healthy employees and workers. Nanda, an ophthalmologist and retinal specialist, said he sees people with blinding eye diseases get back into the workforce through coverage.
He said restricting or curtailing Medicaid expenditures is “short-sighted.” He compared health care spending to fixing a leaky roof – people might not want to pay to fix the roof now, but over time, that leak could turn into a costly flood.
“You fix problems as they come along, rather than delay them,” Nanda said. “And then if you have an unhealthy workforce, you pay a lot more later than you do right now upfront.”
Nanda said that, in 10 years, he hopes Oklahoma can become a more populous state with additional working-age people who can contribute to tax revenue so that Medicaid spending wouldn’t equate to 37% of the state’s budget. He also wants to see more investment in incentivizing businesses to come to Oklahoma, creating additional jobs and revenue.
One important incentive for those businesses, he said, is access to an educated and healthy workforce.
“Private charities and private medical clinics that are funded by charity are just not enough to be able to help the millions of people throughout our state and throughout the country that are deprived of health care,” Nanda said. “I think we have a responsibility as a government to look after those that are vulnerable.”
An Oklahoma Health Care Authority spokesperson said in a statement the agency does not set eligibility policy and would implement any changes adopted through a legislative or other legal process.
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