Health Care & Wellness, Elections & Campaigns
States Move to Revise Voter-Approved Medicaid Expansion Through Ballot Measures
April 1, 2026 | Mary Kate Barnauskas
The Oklahoma House approved two measures to put the Oklahoma Medicaid expansion ballot question back before voters in a special election on August 25, 2026. One proposal (Oklahoma HB 4440 Medicaid) would move expansion from the constitution to statute, while the other would end expansion if federal funding drops below 90 percent. Several states are revisiting voter-approved Medicaid expansion repeal options as federal funding cuts loom over the next decade. Oklahoma, Missouri, and South Dakota all adopted expansion through constitutional amendments, making legislative changes more difficult without returning to voters. South Dakota has already placed a measure on the November 2026 ballot to implement state Medicaid expansion trigger laws, and ten states currently have similar provisions that automatically scale back expansion if federal funding falls below a threshold. The Missouri General Assembly is considering Missouri South Dakota Medicaid work requirements legislation (MO HJR 154) that would eliminate constitutional protections and establish work requirements for the expansion population. While expansion ballot measures have historically been popular with voters, state leaders are arguing that fiscal and policy conditions have changed enough to warrant modifications to these programs.
-eee9cd-400px.jpeg)