Oklahoma Successfully Implements Medicaid Expansion

By Emma Morris, Oklahoma Policy Institute

Since Medicaid expansion became an option for states in 2012, most Oklahoma lawmakers have been reluctant to take advantage of this life-saving opportunity, despite its health, economic, and fiscal benefits. In response to legislative foot-dragging, advocates leveraged the initiative petition process to put the issue to a vote of the people. In June 2020, voters passed the measure, enshrining Medicaid expansion in the state Constitution. After nearly a decade of opportunity, expansion became reality in Oklahoma on July 1, 2021.

More than 135,000 Oklahomans have already been approved for expansion coverage, and some 70,000 more likely qualify. With thousands of newly eligible residents able to see their doctors without financial stress, Oklahomans will be healthier people, better workers, and more financially secure. Expansion also will bring financial benefits statewide, with an estimated 27,000 new jobs, $15.6 billion in economic activity, and nearly $500 million new tax revenue in the first five years.

Implementation of Oklahoma’s expansion has been successful, largely because of legislative commitment to funding the program, our Medicaid agency’s prioritization of enrollment, and a unified effort by a broad coalition of advocates and community members. While the state’s seen a few growing pains,  thousands of Oklahomans newly have access to health insurance, financial stability, and peace of mind.

Advocates, legislators, and agency officials worked together to ensure success

When Oklahoma’s 2021 legislative session began, lawmakers discussed Medicaid expansion funding as a matter of “how,” not “if.” Despite a decade of legislative resistance and continued opposition from the governor, lawmakers — to their credit — honored the will of voters. Though opponents during the campaign weaponized its supposedly high price tag, legislators funded expansion without raising taxes. The program will be fully funded with federal American Rescue Plan Act (ARPA) funds and a phased increase in fees charged to hospitals. As federal pandemic assistance phases out, expansion will likely pay for itself and generate increased revenue.

The Oklahoma Health Care Authority (OHCA) was instrumental in enrolling tens of thousands of Oklahomans into expansion coverage before the program even began. In preparation for the start date, advocates raised concerns that a sudden influx of 200,000 applications could overwhelm the system and that intentional action on the agency’s part would help mitigate the issue. The OHCA announced plans to open a 30-day early enrollment period and to reprocess individuals who had been covered under a less comprehensive plan or who had recently been denied. Because of these efforts, more than 100,000 Oklahomans were approved for expansion benefits within the first ten days of enrollment and were able to access their care beginning on July 1.

With tens of thousands of eligible Oklahomans still unenrolled, advocates and community partners have helped raise awareness by filling in the gap from OHCA’s outreach efforts. Advocates statewide have joined together to provide resources and support in any way possible, including developing and distributing an informational flyer, a step-by-step enrollment guide, and a training video. Several organizations such as health centers, clinics, and service providers have already individually enrolled hundreds of people, and they continue to stand on the front lines and spread the word every day. Oklahoma’s enrollment navigator program provides individual help for anyone who needs it. These efforts have already made a difference and will continue connecting Oklahomans to care.

We can do more to make enrolling easier

As with any undertaking this immense, there have been some snags along the way. Over the past few weeks, there have been anecdotal reports of certain administrative barriers. Individuals have been consistently unable to access parts of their applications and accounts during prime enrollment hours due to scheduled maintenance of the system. Several individuals with disabilities have reported hitting brick walls in the application process because of confusion between state agencies about the new eligibility guidelines. These barriers must be addressed so the state can move forward in the most accessible way possible.

Oklahomans support each other 

Oklahoma has come a long way in the last decade. We have voted to expand Medicaid, fully funded the program, and enrolled thousands of our friends and neighbors into life-saving, affordable coverage. We can build on this momentum to further expand access and make it easier to enroll. In the meantime, we should celebrate that parents can now take care of their children without worrying about their own health care; that college students can access their medications even when parents’ jobs change; that rural residents don’t have to leave their communities to find a job with health care; that individuals leaving incarceration have a better chance at success; and that providers across the state will be strengthened and better able to serve us all. And we should celebrate the fact that we did it together.