Medicaid Expansion

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 ($20,120 per year for one person or $41,400 for a family of four in 2022). The costs of expansion were paid for in full (100 percent) by the federal government through 2016, before dropping 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 expand Medicaid also receive a 5 percentage point increase in their regular federal matching rate for two years after expansion takes 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 were too low-income to qualify for subsidies on the health insurance marketplace, but were too wealthy or not a member 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. As of May 2023, over 330,000 individuals had been approved for benefits under Medicaid expansion.

As of September 2024, 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.