OKPOLICY.ORG
One of the primary provisions of the Affordable Care Act gave states the option to expand their Medicaid eligibility to include individuals below 138 percent of the federal poverty level ($21,597 per year for one person or $44,367 for a family of four in 2025). The costs of expansion were paid for in full (100 percent) by the federal government through 2016, before phasing down and freezing at 90 percent in 2020, well above the typical federal match rate. Under the American Rescue Plan approved by Congress in 2021, states that expanded Medicaid also received a 5 percentage point increase in their regular federal matching rate for two years after expansion took effect.
Until 2020, Oklahoma’s Governor and Legislature opted not to expand Medicaid, a decision that left billions in federal funding on the table, and more than 100,000 Oklahomans in a ‘coverage crater,’ where they earned too little to qualify for subsidies on the health insurance marketplace, but earned too much or were not members of a population group that was eligible to qualify for traditional Medicaid. In June 2020, Oklahoma voters narrowly approved an initiative petition, State Question 802, to expand Medicaid effective July 1, 2021. Over 230,000 Oklahomans gained coverage as a result of Medicaid enrollment as of December 2024, according to Kaiser Family Foundation data.
As of November 2025, 41 states, including Washington D.C., have expanded Medicaid. The ten remaining non-expansion states are: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.
