States Move to Revise Voter-Approved Medicaid Expansion Through Ballot Measures
Last week, the Oklahoma House of Representatives approved two measures that would put the question of Medicaid expansion back on the ballot. In 2020, Oklahoma voters approved a citizen-initiated constitutional amendment that expanded Medicaid under the Affordable Care Act to adults with incomes below 133 percent of the federal poverty level. Because the measure is enshrined in the state constitution, lawmakers cannot make changes to the program without voter approval, setting up a dynamic playing out in several states where legislatures are seeking to revisit voter-approved Medicaid expansion.
Lawmakers have proposed two approaches. One of the proposals (OK HB 4440) would remove Medicaid expansion from the state constitution and place it in statute, allowing lawmakers to repeal or amend the provisions in the future. The second measure (OK HJR 1067) would amend the state constitution to authorize the legislature to end Medicaid expansion if the federal financial participation rate for the program drops below 90 percent. The measures now head to the Senate, and if approved, would be placed on the ballot for a special election on August 25, 2026, for voters to approve or reject. If voters were to approve both measures, the statutory approach would take effect over the conditional trigger. Governor Kevin Stitt (R) framed the effort as necessary to “protect the program for those who really need it” in his State of the State address this year.
https://www.multistate.us/insider/2026/4/1/states-move-to-revise-voter-approved-medicaid-expansion-through-ballot-measures