House Resolution 1, the so-called “Big Beautiful Bill,” eked through the U.S. House of Representatives by a single vote – mostly along party lines – and now is in the U.S. Senate for consideration.
Following is an examination of that legislation on SoonerCare, which is Oklahoma’s Medicaid program for low-income individuals and families, and on other state programs that receive Medicaid, which requires a heavily subsidized federal match to operate.
Currently one in four Oklahomans receive health insurance coverage through SoonerCare. According to the Oklahoma Health Care Authority, as of mid-April, 1,039,983 people were enrolled in SoonerCare; 47% of them (487,853) were adults and 53% (552,130) were children.
The Medicaid sections of H.Res. 1 would:
• Reduce by 10% the Federal Medical Assistance Percentage (FMAP) for Medicaid expansion states that cover the cost of Medicaid for immigrants who are not “qualified aliens.” The FMAP is calculated based on each state’s average per capita income relative to the national average.
• “Sunset” FMAP increase for Medicaid expansion states on Jan. 1, 2026. This is a 5% FMAP increase for two years for states such as Oklahoma, which opted for Medicaid expansion; 10 States have not yet opted for expansion. Oklahoma is one of three states which enshrined Medicaid expansion within our state Constitution.
• Reduce retroactive coverage for Medicaid and the Children’s Health Insurance Program (CHIP) to one month from three months beginning Dec. 31, 2026. According to the Health Care Authority, enrollees in CHIP numbered 85,108 on April 15.
• Prohibit Medicaid funding of gender-affirming care for all individuals.
• Require redetermination of eligibility every six months for expansion populations beginning on Dec. 31, 2026.
• Freeze the current amount of provider taxes for states. These taxes are state-imposed assessments on healthcare providers to help fund Medicaid services. Many states use provider taxes to increase provider payments or to offset potential cuts.
• Require states to impose copays on Medicaid Expansion adults with incomes exceeding 100% of the federal poverty level. This cost-sharing may not exceed $35 per service. Exempted services include primary care services, mental health care services or substance use disorder services.
• Prohibit federal funding for certain entities providing abortion services.
• Increase the state share of Medicaid expansion from 10% to 20% for states that use state-only funds to provide health coverage to undocumented immigrants, placing a greater burden on state budgets should states choose to continue this service.
• Impose work or community engagement activities of at least 80 hours per month for recipients aged 19 to 64 in Medicaid expansion states, starting on Jan. 1, 2029; states would be required to have their systems in place by the end of 2026. Exemptions for this would be pregnant women, foster youth and former foster youth under the age of 26, members of a tribal nation and individuals considered “medically frail,” once verified as such.
Brian Whitfield, chief executive officer of McCurtain Memorial Hospital in Idabel, said that the 80-hour work, job training or volunteer service requirement is “one of the most concerning provisions” in the federal bill.
“While promoting employment is a worthwhile goal, these blanket requirements fail to consider the real- world challenges in rural areas like McCurtain County, where job opportunities, transportation, and child care are often limited or nonexistent,” Whitfield said. “This provision could cut off thousands of Oklahomans – many of whom are already working but in seasonal, informal, or inconsistent roles – from medical coverage they depend on.”
Federal legislation would shift costs of Medicaid to states It has been estimated that approximately $880 billion would be reduced over the next decade through the Medicaid provisions of the legislation, “with much of that shifted to states if they want to continue providing services at current levels,” wrote Joe Dorman, chief executive officer of the Oklahoma Institute for Child Advocacy.
The Kaiser Family Foundation estimates 174,000 Oklahomans would lose SoonerCare benefits under this proposal, with uninsured rates increasing by roughly 95,000, or 2 % of our population, Dorman related.
Rural hospitals face the greatest risk under this proposal, Dorman said.
According to the Center of Health Care Quality and Payment Reform, “67% of rural facilities operate with losses on services and 59% are at risk of closing.” The center’s report states that most atrisk hospitals are in isolated communities where closures would force residents to travel long distances for emergency and inpatient care. Nine rural hospitals in Oklahoma have closed since 2005.
Whitfield wrote in the Southeast Times newspaper that an estimated 50% of Oklahoma’s residents are covered by Medicare, Medicaid or both. The Oklahoma Health Care Authority reports that 123,139 Oklahomans are enrolled in both medical programs.
At McCurtain Memorial Hospital, Medicare and Medicaid “account for 90% of our payer source,” Whitfield reported. “Any disruption to these programs – whether through reduced enrollment or funding cuts – would devastate our hospital’s ability to serve the community and keep our doors open.”
“When patients lose coverage, they don’t stop getting sick,” Whitfield noted. “They still come to the hospital emergency room. They still need cancer screenings, surgeries, mental health care and medications. If we aren’t reimbursed, we simply can’t sustain the level of care we are committed to providing.”
He also said there is an “urgent need” to expand mental health services in rural communities.
“With rising rates of substance use, depression and suicide, access to mental health care is more critical than ever,” Whitfield said. “We should be expanding Medicaid’s scope to support comprehensive mental health services – not erecting new barriers to access.”
“If you have thoughts on parts or all of this legislation, please reach out to our federal delegation for your input on what should happen,” Dorman wrote. Their contact information can be found at https://tinyurl.com/ OKCongDel.