HB 4440: State Medicaid program; Constitutional amendment; requiring state to provide certain medical assistance; requiring Oklahoma Health Care Authority to maximize certain federal action; directing filing. - Oklahoma

Floor (House) → Floor (Senate) · 3 edits

MINOR

The bill was amended to reflect its progression from the House to the Senate floor, resulting in significant formatting and structural changes. The primary substantive change is the addition of a new section that explicitly mandates the state provide Medicaid assistance to low-income adults, clarifying the bill's intent to expand coverage. Technical details regarding the codification of new sections were updated to reflect the Senate's version of the bill.

Scope change

The bill's scope remains focused on repealing specific constitutional sections related to Medicaid work requirements and enacting statutes to expand Medicaid coverage for low-income adults. The Senate version adds explicit language confirming the state's duty to provide medical assistance to this group.

REQUIREMENT

Added a new section explicitly requiring the state to provide medical assistance to low-income adults under the Medicaid program.

TECHNICAL

Updated page headers and titles to reflect the 'Senate Floor Version' instead of the 'House of Representatives - Floor Version'.

Reorganized the layout and numbering of sections to align with Senate formatting standards, including changes to how the ballot title is presented.

HB4440 (4-13-26) (PAXTON) FS FA1.PDF → Floor (House) · 5 edits

MODERATE

The bill was converted from a Floor Substitute to a Committee Substitute, changing its title from Medicaid expansion to a work requirement program. The substantive changes include replacing the constitutional amendment to expand Medicaid eligibility with a new law requiring able-bodied adults to perform 80 hours of work, volunteering, or education per month to receive benefits. The repeal of previous constitutional restrictions on Medicaid is now contingent on federal funding dropping below 90%, and the ballot title was updated to reflect the new work requirement focus.

Scope change

The bill's scope shifted from a constitutional amendment to expand Medicaid eligibility to a statutory work requirement program for Medicaid recipients.

ELIGIBILITY

Replaced a constitutional amendment to expand Medicaid eligibility with a new law requiring able-bodied, working-age adults to perform at least 80 hours per month of work, volunteering, or education to qualify for benefits.

Established five specific exemptions from the work requirement, including persons with disabilities, pregnant individuals, parents of children under 13, and those in substance abuse treatment.

DEFINITION

Added specific definitions for 'Employment', 'Hours per month', and 'Work' to clarify the work requirement standards.

REQUIREMENT

Changed the effective date condition for the repeal of previous constitutional restrictions from a general federal funding threshold to a specific threshold of FMAP below 90%.

TIMELINE

Updated the special election date to August 25, 2026, and revised the ballot title to reflect the implementation of work requirements rather than Medicaid expansion.

House Committee Substitute → HB4440 (4-13-26) (PAXTON) FS FA1.PDF · 3 edits

MINOR

The bill was revised from a 'Committee Substitute' to a 'Floor Substitute' following amendments by the Senate. The core policy remains the same: it orders a legislative referendum to remove constitutional barriers to Medicaid eligibility restrictions and to repeal the original Medicaid expansion if federal funding drops below 90%. The changes are primarily technical, updating the bill's title and authorship to reflect the Senate's involvement and the final floor version of the text.

Scope change

The scope of the bill's legislative history changed from a House-only committee version to a version incorporating Senate amendments, but the substantive policy scope (referendum on Medicaid restrictions and conditional repeal) remains unchanged.

TECHNICAL

The bill title was updated from 'Committee Substitute' to 'Floor Substitute' to indicate it has passed the House committee and been amended by the Senate.

The list of bill sponsors was updated to include Senator Paxton, reflecting the Senate's amendment of the bill.

Minor formatting and line break adjustments were made throughout the document to align with standard legislative formatting for the floor substitute version.

Proposed Committee Substitute (full committee) 1 → House Committee Substitute · 3 edits

MINOR

The bill was amended to update the legislative history and technical details, including the bill number, sponsor information, and request numbers, while retaining the core requirement for Medicaid recipients to perform work or services to maintain eligibility. The substantive policy regarding work requirements, exemptions, and the legislative referendum date remains unchanged.

Scope change

No change to the substantive scope or applicability of the bill; changes are limited to administrative and formatting updates.

TECHNICAL

Updated the bill header to reflect the House Committee Substitute version, changing the title from 'Proposed Committee Substitute' to 'Committee Substitute'.

Changed the request number from 16864 to 17097 and updated the date from March 3, 2026, to March 6, 2026, reflecting the committee's final approval.

Adjusted the sponsor designation from 'Kyle Hilbert-MAH' to 'Hilbert' to align with the official committee substitute format.

Engrossed → Proposed Committee Substitute (full committee) 1 · 5 edits

MODERATE

The bill was completely rewritten from scratch. The original version proposed repealing a constitutional ban on Medicaid expansion and replacing it with new statutes. The new version removes the constitutional repeal entirely, focusing solely on enacting a new law that requires Medicaid recipients to work, volunteer, or attend school to receive benefits, with specific exemptions for certain groups.

Scope change

The bill's scope shifted from a constitutional amendment combined with statutory changes to a purely statutory measure. It no longer seeks to alter the state constitution.

SCOPE

The proposal to repeal Sections 1, 2, 3, and 4 of Article XXV-A of the Oklahoma Constitution was entirely removed.

REQUIREMENT

A new requirement was added mandating that able-bodied, working-age adults must perform at least 80 hours per month of work, volunteering, or education to be eligible for Medicaid benefits.

ELIGIBILITY

Specific exemptions were created for persons with disabilities, those certified unable to work, individuals in substance abuse treatment, pregnant individuals, and parents/guardians of children under 13.

DEFINITION

New definitions were established for 'Employment', 'Hours per month', and 'Work' to clarify the requirements.

TIMELINE

The ballot title and election date remain set for August 25, 2026, but the content of the measure being voted on has changed from a constitutional repeal to a new work requirement law.

Amended And Engrossed → Engrossed · 5 edits · Apr 16, 2026

MODERATE

The bill was amended to remove references to repealing specific sections of the Oklahoma Constitution regarding Medicaid expansion, shifting the focus entirely to enacting new state statutes. The text now explicitly defines 'low-income adults' and mandates that the state provide medical assistance to this group, while also requiring the Oklahoma Health Care Authority to maximize federal funding. The legislative intent has changed from a complex constitutional repeal strategy to a straightforward statutory mandate for Medicaid expansion eligibility.

Scope change

The bill's scope shifted from a hybrid approach involving constitutional amendments and repeals to a purely statutory approach focused on enacting Medicaid expansion provisions into state law.

SCOPE

Removed language proposing to repeal Sections 1, 2, 3, and 4 of Article XXV-A of the Oklahoma Constitution.

ELIGIBILITY

Added a new statutory requirement for the state to provide medical assistance to 'low-income adults' defined as individuals aged 18-65 with income up to 133% of the federal poverty level.

DEFINITION

Introduced specific definitions for key terms including 'Centers for Medicare and Medicaid Services', 'low-income adults', 'medical assistance', and 'Oklahoma Health Care Authority'.

REQUIREMENT

Changed the mechanism from a constitutional referendum to a standard legislative enactment process with a special election ordered for August 25, 2026.

FISCAL

Added a duty for the Oklahoma Health Care Authority to take all necessary actions to maximize federal financial participation in funding medical assistance.

Introduced → Amended And Engrossed · 5 edits · Apr 16, 2026

MODERATE

The bill was amended to replace a generic public health act with a specific Medicaid expansion proposal. The new version orders a legislative referendum to amend the state constitution regarding Medicaid eligibility and to repeal existing constitutional restrictions on Medicaid expansion if federal funding drops below 90%.

Scope change

The bill's scope shifted from a general public health act with a specific effective date to a conditional Medicaid expansion initiative contingent on federal funding levels.

SCOPE

The bill title and subject matter changed from 'Oklahoma Public Health and Safety Act' to a specific Medicaid program amendment and legislative referendum.

ELIGIBILITY

New provisions require the state to provide Medicaid assistance to 'low-income adults' (ages 18-65 with income up to 133% of the federal poverty level) in addition to existing eligible populations.

FISCAL

The bill now includes a trigger condition where constitutional repeals and new provisions only become effective if the federal medical assistance percentage (FMAP) falls below 90%.

TIMELINE

The specific effective date of November 1, 2026, was removed and replaced with a process to submit the measure to voters at the next general election.

REQUIREMENT

New requirements were added for the Oklahoma Health Care Authority to maximize federal funding participation and for the Secretary of State to conduct a legislative referendum.

State Medicaid program; Constitutional amendment; requiring state to provide certain medical assistance; requiring Oklahoma Health Care Authority to maximize certain federal action; directing filing.

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