Budget & Tax, Health Care

Big Beautiful relief for Oklahoma’s state budget

July 10, 2025

Curtis Shelton

The recent signing of the “One Big Beautiful Bill” brings with it a new community engagement requirement for Medicaid-expansion enrollees. Enrollees between the ages of 19 and 64 must adhere to a monthly work requirement or certain qualified activities like community service. 

This will be a welcome reprieve to the Oklahoma state budget, as healthcare costs have ballooned since the state passed Medicaid expansion in 2021.

Over the last decade, total spending by the Oklahoma Health Care Authority (OHCA) has grown by 48 percent when adjusted for inflation. Much of that growth—44 percent—has come since 2021. (SQ 802, the ballot initiative that expanded the state’s Medicaid system, was approved in June 2020.) While it’s true that the federal government has been picking up 90 percent of the cost of new expansion enrollees, the state share of OHCA spending has been growing at an even faster rate, 69 percent, since 2021. 

Sources: Oklahoma Health Care Authority Annual Report Appendices; CPI Inflation Calculator

Sources: Oklahoma Health Care Authority Annual Report Appendices; author’s calculations

As the Oklahoma Health Care Authority continues to eat up a larger share of the state’s budget, any reforms that can help curb that growth will go a long way toward alleviating the stress put on taxpayers by an ever-increasing welfare system. Not only would costs go down, but as more workers re-enter the workforce, we will start to see a stronger state economy and state budget to the benefit of all.

Source: Oklahoma Annual Comprehensive Financial Reports

That is not the only impact this reform will have. Restoring more Oklahomans to the workforce and providing them with the chance to fill a need for someone else goes beyond any strict economic benefits. In a time where an epidemic of loneliness has been declared, connecting people to the value of work beyond just a paycheck is as important as ever.