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.
Click below to jump to a section:
- What is State Question 802?
- The road to the ballot box
- What does the ballot initiative say?
- How will Medicaid expansion be funded?
- General information
- Campaign pages
- Op-eds, editorials, and endorsements
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.
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 announced 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
- Election results for State Question 802 (Oklahoma State Election Board)
- State Question 802: Official Documents and Notices (Oklahoma Secretary of State)
- Outline of the Oklahoma Initiative and Referendum Petition Process (Oklahoma Secretary of State)
- Oklahoma Medicaid Expansion Initiative (2020) (Ballotpedia)
- Oklahoma Council of Public Affairs v. Smalley (Oklahoma State Courts Network)
- Stitt Administration Announces SoonerCare 2.0 (Governor Stitt)
- Yes on SQ 802 – Oklahomans Decide Healthcare
- A No on SQ 802 political action committee was announced but did not create a website
- 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)
- A closer look at SQ 802 results dispels myth that Oklahomans voted against their self-interest (OK Policy)
- Medicaid Expansion in Oklahoma: Creating Jobs, Helping the State Budget, and Protecting Families (Families USA)
- Medicaid Expansion: Ten years of unparalleled returns, improved outcomes (OK Policy)
- Expanding Medicaid can be life-changing for older Oklahomans (OK Policy)
- Study: the US could have averted about 15,600 deaths if every state expanded Medicaid (Vox)
- What you need to know about coverage expansion (OK Policy)
- There are no good reasons not to expand Medicaid (OK Policy)
- Want healthier moms? Expand Medicaid (OK Policy)
- The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Kaiser Family Foundation)
- Medicaid expansion could help address Oklahoma’s surging meth crisis (OK Policy)
- The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid (Kaiser Family Foundation)
- The Implications of Medicaid Expansion in the Remaining States: 2018 Update (Urban Institute/Robert Wood Johnson Foundation)
- Covering the Low Income, Uninsured in Oklahoma: Recommendations for a Medicaid Demonstration Proposal (Leavitt Partners; commissioned by Governor Mary Fallin for the Oklahoma Health Care Authority in 2012)
Op-eds, editorials and endorsements:
- State Chamber of Oklahoma board endorses SQ 802 (NonDoc)
- Statement from Oklahoma Catholic Bishops in support of State Question 802 (The City Sentinel)
- The business case for Medicaid expansion (Ahniwake Rose, Journal Record)
- State Question 802 is pro-business, pro-Oklahoma (Amy Dunn, The Oklahoman)
- Oklahoma City Chamber of Commerce Urges Support of State Question 802 (Press Release)
- Why I support State Question 802 (Cherokee Nation Principal Chief Chuck Hoskin Jr., Tulsa World)
- A chance to save rural hospitals, strengthen state’s economy (Jimmy Leopard, Muskogee Phoenix)
- Ticket to better health, better economy, a stronger state (Jay Johnson, The Oklahoman)
- A chance to show reael gratitude to our essential workers (David Blatt, Tulsa World)
- Child Advocacy Group Endorses SQ 802 (Joe Dorman, The Ada News)
- We endorse SQ 802 for a healthier Oklahoma (Tulsa World)
- Yes on State Question 802 (Stillwater News Press)
- Want more personal responsibility from Oklahoma’s working poor? Medicaid expansion gets us there (Dr. Martin Maxwell, Tulsa World)
- Paying for Medicaid: State Budgets and the Case for Expansion in the Time of Coronavirus (Jonathan Gruber and Benjamin D. Sommers, New England Journal of Medicine)
- On Medicaid expansion, the people of Oklahoma push elected leaders out of the way to force a vote (Tulsa World)
- Life support for rural hospitals (David Blatt, Journal Record)
- Oklahomans tired of waiting for a state Capitol solution can join the movement for Medicaid expansion (Tulsa World editorial)
- Medicaid expansion proponents must question working group’s motives (Muskogee Phoenix editorial)
- Point of View: A funding promise we can count on (Carly Putnam, The Oklahoman)
- New Mexico shows the way on battling opioid overdose deaths, and it starts with Medicaid expansion (Dr. Gerard Clancy, Tulsa World)
- Point of View: Expanding Medicaid makes good business sense for Oklahoma (Patti Davis, The Oklahoman)
- I’m a Tulsa doctor, and I must speak out for Medicaid expansion (Dr. Donald E. Loveless Jr, Tulsa World)