Health care spending is rapidly becoming one of the dominant pressures on Oklahoma’s state budget, and recent changes to federal Medicaid matching rates are leaving lawmakers with a growing problem. 

The charts tell a simple story: total Medicaid spending is surging, and the state’s share is rising even faster—crowding out everything else the state is trying to fund.

Total spending at the Oklahoma Health Care Authority was relatively flat from 2010 to 2020, when voters approved Medicaid expansion via SQ 802. Since then, spending has exploded—from $7.14 billion to $10.56 billion in just four years.

Sources: Oklahoma Health Care Authority Annual Reports; U.S. Bureau of Labor Statistics, CPI Inflation Calculator

The state share dipped during the COVID era, thanks to an unusual flood of federal money. But as those enhanced federal dollars disappear and the match rate falls, the state’s share is heading back upward.

Sources: Oklahoma Health Care Authority Annual Reports; U.S. Bureau of Labor Statistics, CPI Inflation Calculator

And the promise that “free” federal dollars would carry the load has simply not materialized. Since the Medicaid expansion in 2021, the state's share of OHCA spending has grown faster than the federal share.

Sources: Oklahoma Health Care Authority Annual Reports; U.S. Bureau of Labor Statistics, CPI Inflation Calculator

This expanding Medicaid footprint is squeezing out other legislative priorities. Despite multiple years of substantial budget growth, OHCA is still seeking hundreds of millions more in state appropriations—even as Oklahoma’s health outcomes fail to improve.