Medicaid expansion can address Oklahoma’s mental health and criminal justice needs (Capitol Update)

Last week, the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) board approved the agency’s FY 2021 spending plan. The bad news is the budget contained a $14 million cut from the previous year. ODMHSAS had requested a $188.9 million increase for FY 2021, which begins July 1. The budget cut was unavoidable due to the crash in the economy caused by loss of oil and gas revenues and COVID-19, but this cut adds to chronic underfunding of mental health. 

Oklahoma consistently ranks high in mental illness and addiction. According to Mental Health America’s 2020 report, Oklahoma ranks 41st in mental illness and substance use disorders, which means Oklahomans have a higher prevalence of mental illness and lower access to care. The American Foundation for Suicide Prevention’s 2020 report shows Oklahoma ranks 10th in the nation for suicides with 20 suicides per 100,000 population. At the same time, Governing magazine in 2020 ranked Oklahoma 46th in mental health spending. To have any hope of aspiring to “top 10” status in fighting mental illness and addiction, Oklahoma needs a large infusion of dollars into ODMHSAS. 

As luck would have it, that may now be possible. More than 313,000 Oklahomans signed the petition for State Question 802, which would expand Medicaid coverage that would pump over $1 billion annually into Oklahoma health care. We can make that happen on Tuesday. One of the areas that stands the most to gain from Medicaid expansion is mental health and addiction coverage for thousands of low-income people not now covered. With 90 percent being paid for by our own federal tax dollars currently being forfeited, the treatment will help families and save thousands of lives.

Another important benefit of Medicaid expansion will be the improvement of criminal justice in Oklahoma, which remains an urgent need. Of the $188.9 million FY 2021 budget increase requested by ODMHSAS last year, $80.2 million was for its “Smart on Crime” initiative

The “Smart on Crime” dollars would pay for crisis-intervention training for police officers; pretrial support services; expanding a day reporting program now existing only in Oklahoma county because of lack of resources; early offender screening for mental health and addiction; drug, mental health, and family treatment courts; misdemeanor diversion programs; juvenile diversion; and treatment for offenders during and after incarceration. As Lt. Gov. Matt Pinnell would say, “imagine that.” 

Other states have used Medicaid expansion dollars for these kinds of criminal justice programs. Better mental health and addiction outcomes, lower suicide rates, lower incarceration rates, and criminal justice reform would all benefit with a YES vote on Tuesday for Medicaid expansion.


Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1990. He currently practices law in Tulsa and represents clients at the Capitol.

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