SQ 802: Medicaid Expansion – Information and resources

Carly Putnam // July 19, 2019 // Updated: May 26, 2020
Advocacy Alerts // Featured Voting & Elections // // //

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 has endorsed SQ 802; you can see our statement of support here and find out how to get involved with the SQ 802 campaign here.

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What is State Question 802?

State Question 802 is an initiative petition that will give Oklahoma voters the chance on June 30, 2020 to expand Medicaid to cover low-income adults in Oklahoma beginning no later than July 1, 2021.

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

To date, Oklahoma is one of just 14 states that has 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.

Where are things now?

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. The last day to register to vote in the June 30 primary election is June 5, and the last day to request an absentee ballot will be June 24.

Note that the absentee voting rules for the June 30th election were modified by the Legislature in May with the passage of SB 210. Voters have a new option for absentee voter verification during the COVID-19 state of emergency. Instead of having your signature notarized or witnessed by two people, you now have the option of attaching a copy of an identification document to your affidavit envelope. Please see the State Election Board website for detailed information.

Meanwhile, Governor Stitt, an avowed opponent of SQ 802, announced an alternative approach to Medicaid expansion earlier this year that was dubbed SoonerCare 2.0. The Governor’s plan called for a state plan amendment to extend coverage to low-income adults effective July 1st of this year, followed by a waiver proposal that, if approved by the federal government, would have subjected the newly-eligible Medicaid population to monthly premiums and community engagement (work reporting) requirements, while enacting a per person expenditure cap. The Legislature passed SB 1046, which raised the hospital provider fee to cover the state’s share of the expansion population as of July 1st. However, Gov. Stitt vetoed the bill on the grounds that current economic circumstances would lead too many people to enroll in Medicaid. The Governor’s veto means that his SoonerCare 2.0 proposal is effectively off the table, leaving SQ 802 as the sole path to Medicaid expansion.

What has happened already?

The state legislature seriously considered expansion for the first time in 2019, when SB 605 became the first Medicaid expansion bill heard in a legislative committee. Although the bill passed out of committee unanimously, it died when it was not heard before the next legislative deadline.

The ballot initiative process in Oklahoma formally 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 Council for Public Affairs  filed a legal challenge shortly thereafter, alleging that SQ 802 was unconstitutional and the gist was inadequate. The state Supreme Court disagreed, and on June 19, the state Supreme Court cleared the way for a Medicaid expansion ballot initiative, or State Question, to move forward.

Advocates began collecting signatures to place SQ 802 on the ballot on July 31, 2019. Organizers had until 5pm on October 28, 2019 to collect some 178,000 signatures (15 percent of the total number of votes cast in the last gubernatorial election).  On October 24th, organizers turned in some 313,000 signatures to the Secretary of State, far surpassing the number of valid signatures needed to get on the ballot. The Secretary of State counted 299,371 signatures, far above the number needed 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. 

What does the ballot initiative say?

The official ballot title for State Question 802, as amended by Attorney General Mike Hunter, reads 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.                                                                                           

General information:

Campaign Pages:

How to Get Involved:

News:

  • 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 and editorials:

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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.