SQ 802: Medicaid Expansion – Information and resources

Carly Putnam // July 19, 2019 // Updated: March 25, 2021
Advocacy Alerts // // //

This page is a resource on the Oklahoma Medicaid expansion ballot initiative (SQ 802). It will be updated to reflect the most recent information available. OK Policy endorsed SQ 802; you can see our statement of support here.

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What is State Question 802?

State Question 802 was an initiative petition that gave Oklahoma voters the chance to expand Medicaid to cover low-income adults in Oklahoma beginning no later than July 1, 2021. SQ 802 passed on June 30, 2020, receiving 50.45 percent of the vote.

The ballot initiative was run by the group Yes on SQ 802: Oklahomans Decide Healthcare. Medicaid expansion in Oklahoma would cover approximately 200,000 people.

At the time of passage, Oklahoma was one of just 14 states that had not expanded its Medicaid programs to include low-income working adults. Thirty-six states and Washington, DC have expanded Medicaid. Medicaid expansion was authorized by the Affordable Care Act and became available to states in 2014.

The road to the ballot box

The ballot initiative process in Oklahoma began in April 2019, when two Oklahoma women, Kelly Smalley and Erin Taylor, filed a petition with the Oklahoma Secretary of State. It was designated State Question 802 (SQ 802) by the Secretary of State’s office. The Oklahoma Supreme Court rejected a legal challenge to the petition filed by the Oklahoma Council of Public Affairs, which cleared the way for SQ 802 to move forward.

Advocates began collecting signatures to place SQ 802 on the ballot on July 31, 2019.  On October 24th, organizers turned in some 313,000 signatures, far surpassing the number of valid signatures (178,000) needed to get on the ballot. The Secretary of State counted 299,371 signatures, more than  enough to qualify for the ballot. On November 14th, the Attorney General submitted a revised ballot title for State Question 802.

Oklahoma’s efforts to expand Medicaid via ballot initiative follow successful expansion ballot initiatives in four states: Maine in 2017, and Nebraska, Idaho, and Utah in 2018. In all four states, the Governor and/or Legislature has sought to roll back or limit the full expansions approved by voters. This prompted organizers in Oklahoma to seek a constitutional rather than statutory amendment – putting Medicaid expansion in the state constitution limits the state Legislature’s ability to tamper with it.

In May 2019, Governor Kevin Stitt said he expected to unveil a customized Medicaid expansion plan in late summer or early fall 2019. In July, legislative leaders announced the formation of a bicameral working group, chaired by Sen. Greg McCortney (R-Ada) and Rep. Marcus McEntire (R-Duncan), to develop a plan to expand access to health care and increase coverage of uninsured Oklahomans. The working group’s first meeting was August 14th and it continued to hold regular meetings throughout the fall. As part of the Governor’s efforts to develop an alternative to Medicaid expansion, in November, the Oklahoma Health Care Authority signed a $1.5 million contract with Health Management Associates to develop a plan to redesign the state’s health care system. On January 30th, 2020, Governor Stitt attended a press conference in Washington, D.C. with CMS Administrator Seema Verma where she announced a new Medicaid waiver option for states. This initiative, which the Trump Administration calls the Healthy Adult Opportunity, is intended to convert Medicaid funding into a block grant.  On March 16th, Gov. Stitt unveiled a plan dubbed SoonerCare 2.0 that directed the Oklahoma Health Care Authority to apply for a federal waiver under the Healthy Adult Opportunity that would, among other things, enact a per-person expenditure cap, charge premiums for the expansion population, and pursue community engagement (work reporting) requirements. The waiver proposal provided for a 30-day public comment period, which ran through April 15th. OK Policy expressed grave concern that the short public comment period in the midst of the COVID-19 pandemic did not allow the agency, advocates, patients, and providers to give this matter the full attention it deserves. 

On January 9th, 2020, the Secretary of State certified that all requirements for placing the initiative petition on the ballot have been successfully satisfied. 

On April 17th, Governor Stitt anounced that SQ 802 would appear on the June 30th statewide primary election ballot.

After the passage of SQ 802, Governor Still and the Oklahoma Health Care Authority dropped the SoonerCare 2.0 waiver proposal. However, they moved ahead with a plan to have managed care organizations operate most of the Medicaid program by the end of 2021.

What did the ballot initiative say?

The official ballot title for State Question 802, as amended by Attorney General Mike Hunter, read as follows:

Medicaid is a government-sponsored health insurance program for qualifying low-income persons. This measure would add a provision to the Oklahoma Constitution requiring the State to expand Medicaid coverage. The expanded coverage would include certain persons over 18 and under 65 who are not already covered and whose annual income, as calculated under federal law, is at or below 133 percent of the federal poverty line. The federal poverty line changes annually, but for example if this measure were in effect in 2019, the measure generally would have covered a single adult making less than $17,236 annually and adults in a family of four making less than $35,535 annually.

Under this measure the State cannot create additional restrictions that make it more difficult to qualify for expanded Medicaid coverage than it is to qualify for the Medicaid program currently in place.

The Medicaid program is funded jointly by the federal government and the State. This measure would require the Oklahoma Health Care Authority (OHCA) to try to maximize federal funding for Medicaid expansion in Oklahoma. If the measure is approved, OHCA has 90 days to submit all documents necessary to obtain federal approval for implementing Medicaid expansion by July 1, 2021.

How will Medicaid expansion be funded?

The federal government will pay 90 percent of the cost of the Medicaid expansion population in perpetuity, as specified in federal law. The state of Oklahoma will cover the remaining 10 percent. The Legislature will need to specify a funding source for the state share in the 2021 session; multiple funding options are on the table, including raising the Supplemental Hospital Offset Payment Program (SHOPP) fee on hospitals, earmarking a share of tobacco settlement revenues, and allocating general revenues.  Under the American Recovery Plan Act passed by Congress in March 2021, all states that have not yet expanded Medicaid, including Oklahoma, were promised a 5 percentage point increase in their base federal Medicaid match rate, known as FMAP, for two years after the state expands coverage.  Under this provision, Oklahoma could receive between $520 million and $860 million, which would more than cover the estimated cost of Medicaid   expansion                                                                                      

General information:

Campaign Pages:

News:

  • Medicaid expanded: State Question 802 passes by a hair (NonDoc)
  • Governor Stitt vetoes hospital fee for Medicaid expansion (NonDoc)
  • With vote set for Medicaid expansion, how does SQ 802 compare with Stitt’s plan? (Oklahoma Watch)
  • A Medicaid expansion showdown, 10 years in the making (NonDoc)
  • At Medicaid block grants announcement, Stitt pitches SQ 802 alternative (NonDoc)
  • Medicaid expansion campaign turns in 313,000 signatures, breaks record (Oklahoman)
  • Medicaid petition makes goal of 178,000 signatures, campaign says (Tulsa World)
  • Advocates push Medicaid expansion in Oklahoma (StateImpact Oklahoma)
  • ‘Leaving billions of dollars on the table’: Rural hospitals foundering in states that declined Obamacare (Gatehouse News)
  • ‘Yes on 802’ making way through Oklahoma (Duncan Banner)
  • SQ 802: Court moves Medicaid expansion effort forward (NonDoc)
  • Proponents rally, urges lawmakers to expand health coverage now (The Oklahoman)
  • Oklahoma’s rural hospitals see a lifeline in Medicaid expansion (StateImpact Oklahoma)

Studies:

Op-eds, editorials and endorsements:

Click here to read more op-eds and editorials on SQ 802.

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ABOUT THE AUTHOR

Carly Putnam // Twitter @CarlyPutnam // cputnam@okpolicy.org

Carly Putnam joined OK Policy in January 2014. She previously worked as an OK Policy intern. A Kansas City native, Carly graduated from the University of Tulsa in December 2013 with a BA in Sociology and Women’s and Gender Studies. As a student, she was a participant in the National Education for Women (N.E.W.) Leadership Institute and interned with Planned Parenthood. She is a graduate of the Oklahoma Center for Nonprofits Nonprofit Management Certification Program, the Oklahoma Developmental Disabilities Council’s Partners in Policymaking program, and The Mine, a social entrepreneurship fellowship in Tulsa. She previously served as board president for United Campus Ministry at the University of Tulsa. At OK Policy, Carly supervises policy staff and conducts research focusing on health care and the safety net.