Want to improve the mental health of Oklahomans? Expand Medicaid.

Oklahoma is in crisis.  While need for mental health care climbs, Oklahomans overwhelmingly lack access to the care needed to address these sometimes preventable, always treatable conditions. This has serious consequences: untreated mental illness can mean increased risk for other health problems, incarceration, difficulty keeping a job and keeping up with financial responsibilities, and homelessness. Many people experiencing a mental illness enter our criminal justice system because of their illness: in 2017, 10,000 individuals with a mental illness passed through the county jail in Tulsa alone. Other outcomes are more tragic: our suicide rate increased 45 percent between 2009 and 2016. Oklahoma ranks 8th in the nation for incidence of suicide according to American Foundation for Suicide Prevention.

Accepting federal funds for Medicaid expansion is the most practical way to address this crisis. Expanding Medicaid allows states to provide access to care to adults who earn up to 138 percent of the federal poverty level ($16,753 per year for an individual). More than 150,000 Oklahomans will gain access to health care through Medicaid expansion.  This includes some of the 97,000 uninsured Oklahomans with a mental health diagnosis, roughly the entire population of Broken Arrow. Increased access to health care through Medicaid expansion reduces costs for states and helps people with mental illness return to the workforce.

Mental healthcare in Oklahoma is inadequately funded

Oklahoma ranks 46th in the nation in spending on mental health care. Funding for mental health services in Oklahoma has never been adequate but cuts over the last four years were particularly devastating. The Oklahoma Department of Mental Health and Substance Abuse (ODMHSAS), the primary provider for low-income, uninsured adults, lost $52.6 million in state funding between 2014 and 2018, resulting in a loss of $80.4 million in matching funds from the federal government and deep cuts in services and provider rates as a result ODMHSAS will receive an $11 million increase in 2019, but this increase is only the beginning of restoring what was cut. By contrast, expanding access to care to low-income adults through Medicaid expansion will bring over $8 billion  in federal funds to Oklahoma, nearly 8 times what ODMHSAS got this year. This will significantly increase the state’s capacity to provide needed care to those who are more likely to experience poor mental health.

Without investment in health care, it is difficult and – at times impossible – for people with a mental illness to get treatment. Oklahoma has the second-highest rate of uninsured working-age adults in the US. ODMHSAS provides care through state dollars for uninsured, low income Oklahomans who would be covered by Medicaid expansion. Last year, they served nearly 200,000 Oklahomans, and still only 1 in 3 Oklahomans who experience any form of mental illness get the care they need.

This lack of funding and resources in turn limits mental health providers across the state because they are forced to only treat those who are experiencing the most severe mental health problems. People with less severe mental health problems are turned away and asked to come back when they are sicker and closer to – or actually in – crisis, at a risk of harming themselves or others. By the time they finally get the help they need, it’s far more resource- and time -intensive, and often less effective than early intervention. Insufficient funding results in unnecessary suffering for those with a mental illness and in the end, actually cost more.

Medicaid expansion is a cost-effective way to improve access to care and quality of life

Mental health care is improving in states that expanded Medicaid, making it easier for people who need care to get it compared to non-expansion states like Oklahoma. Fewer people with depression are uninsured after Medicaid expansion, and those individuals also report fewer delays in care and fewer barriers to getting medication after getting coverage. Compared to non-expansion states, expansion states cut the number of mental health hospital stays nearly in half. Medicaid expansion also reduces deaths due to suicide and substance abuse, which commonly co-occur with a mental health diagnosis.

In addition to improving the mental health of thousands of Oklahomans, expanding Medicaid will alleviate pressure on the state budget.  Mental health services for those low-income, uninsured individuals who would be eligible for coverage under expansion are currently funded by state-only dollars. Expanding access to care would allow the state to provide these services using federal dollars and free up existing funds for other important priorities, including prevention and supports like housing and programs that support individuals with mental health diagnoses getting back to school or back in the workforce. Increasing access to mental and behavioral health treatment also reduces rates of disability, increases employment productivity and can reduce criminal justice spending.

The bottom line

Every year, Oklahoma accepts federal funding for transportation, education, food assistance, and healthcare. In 2015, federal funds comprised nearly 40 percent of the state’s budget. Oklahomans’ federal tax dollars are being used to improve and expand healthcare in other states while Oklahomans are turned away from the care they need. It is time to accept federal dollars for Medicaid expansion and invest in the health and wellness of our own communities


Lauren Turner joined Oklahoma Policy Institute in October 2018 as the mental health policy analyst and coordinator of the Mental Health Policy Fellowship. She is a native Tulsan who has spent the entirety of her career working in social services in Northeastern Oklahoma, including work in inpatient and outpatient mental health settings, the HIV/AIDS community, and anti-trafficking efforts in the Tulsa area. She was a research assistant and Knee Center for Strong Families Scholar at the University of Oklahoma. She received a B.S in Family and Human Services from John Brown University in 2010 and a Master of Social Work degree from the University of Oklahoma in 2016. She became a Licensed Master Social Worker in July 2016.

4 thoughts on “Want to improve the mental health of Oklahomans? Expand Medicaid.

  1. Very persuasive argument. Helping the mentally ill is in itself the right and humane thing to do. Finding the the funding, as you have done almost completes the picture. The money saved as result of having more heathy citizens might easily out way the cost of their care in terms of productivity and not having to pay for uncivil activities due to their illness. Thank you for your research and conclusions

  2. AN INITIATIVE PETITION? Is that a tact that could address this need for expansion of medicare? If so how? and If so, put me down for helping make it happen.
    Thanks for all you all do.

  3. Very thorough article. State legislators should look at Medicaid expansion as a new business looking to relocate here with $1 Billion in annual revenue and bringing 1000s of good paying jobs. The economic incentives -local & state- plus all the sales, income and property taxes to be paid by those 1000s of jobs would easily be 10% of $1 Billion annual revenue. Add in state spending reductions to Oklahoma Department of Mental Health and Substance Abuse, Ok Dept of Corrections and other state agencies impacted. Medicaid expansion would increase state revenue, not cost the state $100M/yr as Gov & state legislators have claimed.

  4. Thank you for re-printing this article. As a member of the Legislative Healthcare Taskforce, I hear about the negative possible consequences, but the possible positive benefits are left out. This article highlights one. I am excited about the petition and looking forward to dealing with our efforts to improve health standards in Oklahoma. Not as excited about what may come out of the Taskforce, yet I am hopeful.

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