Voters will get the chance to address Oklahoma’s exploding Medicaid costs, which threaten to divert hundreds of millions of dollars from things like schools and public safety, under two pieces of legislation approved by members of the Oklahoma House of Representatives this week.

A 2020 ballot measure, which passed by the narrowest of margins due only to mail-in ballots, expanded Oklahoma’s Medicaid program to provide taxpayer-funded welfare benefits to able-bodied adults, many of them males in their 20s and 30s.

Now Medicaid expansion is creating massive budget challenges. The Oklahoma Health Care Authority, which administers Medicaid, requested an additional state appropriation of nearly $500 million this year alone, due in part to surging costs related to the expansion population.

House Bill 4440, by House Speaker Kyle Hilbert, would allow Oklahoma voters to remove Medicaid expansion mandates from the state constitution and instead place expansion in state law, allowing lawmakers to amend the law as financial conditions require in future years.

Hilbert said that change is “very necessary.” He said having Medicaid expansion in the Oklahoma Constitution effectively requires lawmakers to impose draconian cuts to Medicaid provider rates whenever the program faces shortfalls.

“Currently, Medicaid budgets are increasing dramatically, and ultimately, there are only two mechanisms with which to decrease the expenditures of Medicaid,” said Hilbert, R-Bristow. “One is to reduce who qualifies for Medicaid expansion and what benefits they get. The other is the provider rates. And, unfortunately, due to Medicaid expansion being in our state constitution, we have only one lever available to us with which to reduce Medicaid spending. And it is essential that the people of Oklahoma fix the mistake that we made putting Medicaid expansion in our constitution.”

Hilbert warned that if Medicaid expansion remains in the Oklahoma Constitution, “there will be rate cuts” for providers since that is the only cost-control mechanism available. That, in turn, will mean people on Medicaid will not have access to health care treatment.

“If you don’t have health care providers because they close because of provider rate cuts, which are inevitable if this fails, then it doesn’t matter that you have Medicaid expansion because you’re not going to have any providers to access,” Hilbert said.

House Democratic Leader Cyndi Munson of Oklahoma City dismissed concerns about Medicaid expansion’s exploding costs, saying lawmakers should raise taxes on Oklahomans to cover any shortfalls.

“The governor has even touted a $1.6 billion cut from our budget because of income-tax cuts,” Munson said. “What if we had that revenue?”

Reversing the $1.6 billion in tax cuts cited by Munson would involve raising income taxes on all Oklahomans earning more than $7,200 for single filers and $12,200 for joint filers, as well as reimposing the 4.5 percent state sales tax on groceries.

HB 4440 passed the Oklahoma House of Representatives on a 74-18 vote that mostly broke along party lines, with Republicans in support and Democrats opposed.

House lawmakers also approved House Joint Resolution 1067, by state Rep. Ryan Eaves, which would allow Oklahoma voters to amend the state constitution to repeal Medicaid expansion if the federal match is cut below the current 90-10 federal-state split for the expansion population of able-bodied adults.

Through the years, federal officials have repeatedly discussed lowering the federal match by a substantial amount, including proposals floated by the Obama administration. Any change in the federal match would effectively create hundreds of millions of dollars in new state costs for Oklahoma government and force cuts to other areas of government, such as schools, roads, and public safety.

“HJR 1067 is a proposal that hopefully promises greater control over our state’s future and enhances flexibility in managing our health care system,” said Eaves, R-Atoka. “At its core, HJR 1067 is about empowerment—empowering the people of Oklahoma to decide how our state participates in Medicaid expansion under federal law. It protects Oklahoma’s fiscal stability, preserves flexibility in health policy, encourages responsible expansion based on federal support, and upholds the principles of local control.”

HJR 1067 would not take effect if voters also approve the proposal submitted through HB 4440.

HJR 1067 passed the Oklahoma House of Representatives on a 74-19 vote that mostly broke along party lines, with Republicans in support and Democrats opposed.

In his State of the State address in February, Gov. Kevin Stitt urged lawmakers to send a constitutional amendment to the voters to address Medicaid’s problems.

“Government dependency is a trap. It robs self-reliance and it balloons budgets,” Stitt said. “I always say government programs should be a trampoline, not a hammock, but too often that is not the case. Medicaid is Exhibit A. It’s driving massive spending growth while enabling waste. In 10 years, Medicaid is projected to eat up 37 percent of our annual budget—$6 billion dollars. We have to make a change.”

In addition to causing significant financial problems for state government, Medicaid expansion has failed to deliver any meaningful benefit.

Promised Benefits Have Not Materialized 

At an October 2025 legislative study, officials with the Oklahoma Hospital Association told lawmakers that profit margins at Oklahoma’s rural hospitals are weak, ranking 35th out of the 50 states, while rural hospitals in Texas ranked 11th-best nationally in total margin.

Notably, Texas has not expanded its Medicaid program to include able-bodied adults, unlike Oklahoma.

And Oklahoma Hospital Association officials told lawmakers that 53 percent of rural Oklahoma hospitals were at medium-to-high risk of closure in 2023, the most recent data available.

Several reports have found that hospitals in Oklahoma are on more precarious financial footing today than prior to Medicaid expansion. That’s due in part to the fact that Medicaid rates don’t cover the cost of treatment, as even a hospital executive who endorsed Medicaid expansion previously acknowledged.

A 2024 study from the Foundation for Government Accountability (FGA) reviewed the federal filings of more than 4,000 hospitals nationwide. In 2013, the final year before Medicaid expansion was implemented under the federal Affordable Care Act (“Obamacare”), the FGA report showed that hospitals in states that embraced expansion reported just over $10 billion in losses due to Medicaid. By 2021, those Medicaid losses had ballooned to $22.3 billion, an increase of 115 percent.

In contrast, hospitals in non-expansion states saw their Medicaid shortfalls increase by only 6 percent.

A September 2025 report from the Foundation for Government Accountability similarly noted that Medicaid expansion is “shuttering hospitals” with 74 hospitals having closed in states after they expanded Medicaid.

Medicaid expansion has also failed to improve health outcomes.

The Commonwealth Fund’s “2025 Scorecard on State Health System Performance” report showed that deaths per 100,000 population before the age of 75 from health care-treatable causes rose after Medicaid expansion in Oklahoma, and the rate in nearly all states that have not expanded Medicaid was better than the rate in Oklahoma.

Oklahoma ranked 48th on health outcomes and healthy behaviors, according to the Commonwealth Fund, while some non-expansion states did significantly better, such as Florida (ranked 20th in health outcomes) and Texas (27th).

Ironically, Munson tacitly conceded the failure of Medicaid expansion to improve health outcomes during her debate against HB 4440.

“We continue to be in a health-care crisis,” Munson said. “We still always rank somewhere between 47th and 48th in the nation for health care.”

HB 4440 and HJR 1067 now proceed to the Oklahoma Senate.