Stitt calls for ballot question to change Oklahoma Medicaid expansion, prompting warnings from hospital and physician leaders

What the governor is proposing

Gov. Kevin Stitt is urging Oklahoma lawmakers to place a state question on a future ballot that would allow “adjustments” to the state’s Medicaid expansion. In his 2026 State of the State address, Stitt argued that Medicaid spending is growing rapidly and said the program is projected to represent 37% of the state budget within a decade, totaling about $6 billion.

Stitt did not detail specific policy changes he wants to make to the expansion. However, his remarks tied the request to a broader effort to tighten administration of public benefits and promote employment among able-bodied adults.

Why changing expansion is legally complex in Oklahoma

Oklahoma’s Medicaid expansion was adopted through State Question 802, approved by voters on June 30, 2020, and implemented July 1, 2021. Because the expansion requirement is embedded in the Oklahoma Constitution, altering key elements typically requires another constitutional amendment approved by voters rather than a standard legislative change.

The measure expanded eligibility to adults ages 19 to 64 with incomes up to 138% of the federal poverty level. It also limited the state’s ability to create additional restrictions that make it harder to qualify for the expansion coverage than for the pre-existing Medicaid program.

Recent executive action and the policy backdrop

On Jan. 26, 2026, Stitt signed an executive order directing state agencies to conduct a broad review of public assistance programs, including Medicaid, SNAP, and others. The order calls for audits of error rates, reviews of eligibility rules and “benefit cliffs,” and preparation of waiver requests seeking federal flexibility. It also outlines steps such as expanded identity verification, data matching, and public reporting.

Stitt has also pointed to work-oriented policy tools as part of the overall approach to public benefits, framing the effort as aimed at reducing fraud and encouraging workforce participation.

Concerns raised by hospital and physician organizations

Health care leaders have said the governor’s call for “adjustments” lacks operational detail and could introduce uncertainty into coverage and provider finances. Hospital and physician representatives have emphasized that Medicaid expansion was intended to increase access to care and improve health outcomes, including in rural communities where hospitals often rely heavily on Medicaid reimbursement.

They also argued that work-related provisions and other administrative tools already provide avenues for the state to shape program operations without rewriting the constitutional expansion framework. From the provider perspective, curtailing eligibility or reducing enrollment could shift care toward uncompensated emergency treatment and destabilize facility budgets.

Key facts and figures shaping the debate

• Expansion coverage applies to adults ages 19–64 up to 138% of the federal poverty level.
• Oklahoma’s expansion is constitutionally rooted, making changes more difficult than in most states.
• The federal government finances 90% of the cost for the expansion population, with the state responsible for 10%.

The governor’s request sets up a policy and political test: whether lawmakers will pursue a voter-approved constitutional change to a program that has reshaped health coverage since 2021.

What happens next

For a ballot question to advance, legislative leaders would need to pass the necessary measure to send a constitutional proposal to voters. Without a defined package of proposed changes, debate is likely to focus first on what “adjustments” would mean in practice—eligibility rules, administrative requirements, financing, or other structural revisions—and how those choices would affect patients, providers, and the state budget.