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ENGR. S. A. TO ENGR. H. B. NO. 4440 Page 1
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ENGROSSED SENATE AMENDMENT
TO
ENGROSSED HOUSE
BILL NO. 4440 By: Hilbert and Lepak of the
House
and
Paxton of the Senate
An Act relating to public health and safety;
ordering a legislative referendum pursuant to the
Oklahoma Constitution to amend the Oklahoma
Constitution by repealing Sections 1, 2, 3 and 4 of
Article XXV-A; ordering a legislative referendum;
providing for enactment of statutes related to
Medicaid and Medicaid expansion; defining terms;
requiring certain medical services be made available
to certain persons; imposing duty on Oklahoma Health
Care Authority; providing ballot title; ordering a
special election; and directing filing.
AMENDMENT NO. 1. Page 1, strike the title, enacting clause and
entire bill and insert
“An Act relating to the state Medicaid program;
directing the Secretary of State to refer to the
people for their approval or rejection a proposed
amendment to Section 2 of Article XXV-A of the
Oklahoma Constitution; removing prohibition for
imposing certain eligibility restrictions; directing
the Secretary of State to refer to the people for
their approval or rejection a proposed amendment to
repeal Sections 1, 2, 3, and 4 of Article XXV-A of
the Oklahoma Constitution, which relate to Medicaid
expansion; making repealers contingent upon certain
federal action; ordering a legislative referendum;
defining terms; requiring state to provide certain
medical assistance; requiring Oklahoma Health Care
Authority to maximize certain federal funding; making
provisions contingent upon certain federal action;
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providing ballot title; providing for codification;
and directing filing.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. The Secretary of State shall refer to the people for
their approval or rejection, as and in the manner provided by law, a
proposed amendment to Section 2 of Article XXV-A of the Oklahoma
Constitution to read as follows:
Section 2. A. In addition to those otherwise eligible for
medical assistance under Oklahoma’s Medicaid program, the State
shall provide medical assistance under Oklahoma’s Medicaid program
to Low Income Adults.
B. No greater or additional burdens or restrictions on
eligibility or enrollment shall be imposed on persons eligible for
medical assistance pursuant to this Article than on any other
population eligible for medical assistance under Oklahoma’s Medicaid
program.
SECTION 2. The Secretary of State shall refer to the people for
their approval or rejection, as and in the manner provided by law, a
proposed amendment to repeal Sections 1, 2, 3, and 4 of Article XXV-
A of the Oklahoma Constitution. Such repeal will only occur if the
federal medical assistance percentage (FMAP) established under 42
U.S.C., Section 1396d(y) is reduced below ninety percent (90%).
SECTION 3. Pursuant to Section 3 of Article V of the Oklahoma
Constitution, there is hereby ordered the following legislative
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referendum which shall be filed with the Secretary of State and
addressed to the Governor of the state, who shall submit the same to
the people for their approval or rejection at the next general
election.
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1011.26 of Title 56, unless
there is created a duplication in numbering, reads as follows:
A. As used in this section:
1. “Low-income adults” refers to those individuals over
eighteen (18) years of age and under sixty-five (65) years of age
whose income does not exceed one hundred thirty-three percent (133%)
of the federal poverty level, as described by and using the income
methodology provided in the federal Medicaid statute at 42 U.S.C.,
Section 1396a(a)(10)(A)(i)(VIII), and who meet applicable
nonfinancial eligibility conditions for Medicaid under 42 C.F.R.,
Part 435, Subpart E;
2. “Medical assistance” means payment of part or all of the
cost of the care and services, or the care and services themselves,
or both, as provided in the federal Medicaid statute, 42 U.S.C.,
Section 1396 et seq.; and
3. “Oklahoma Health Care Authority” refers to the single state
agency responsible for administering the state Medicaid program
pursuant to 42 U.S.C., Section 1396a(a)(5).
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B. In addition to those otherwise eligible for medical
assistance under the state Medicaid program, the state shall provide
medical assistance under the state Medicaid program to low-income
adults.
C. The Oklahoma Health Care Authority shall take all actions
necessary to maximize federal financial participation in funding
medical assistance pursuant to this section.
D. The provisions of this section shall only become effective
if the federal medical assistance percentage (FMAP) established
under 42 U.S.C., Section 1396d(y) is reduced below ninety percent
(90%).
SECTION 5. The proposed Constitutional amendment as set forth
in SECTION 2 of this act and the statutory provisions as set forth
in SECTION 4 of this act shall only become effective if the federal
medical assistance percentage (FMAP) established under 42 U.S.C.,
Section 1396d(y) is reduced below ninety percent (90%).
SECTION 6. The Ballot Title for the proposed Constitutional
amendments as set forth in SECTIONS 1 and 2 of this act and the
legislative referendum as ordered in SECTION 3 of this act and as
set forth in SECTION 4 of this act shall be in the following form:
BALLOT TITLE
Legislative Referendum No. ____ State Question No. ____
THE GIST OF THE PROPOSITION IS AS FOLLOWS:
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This measure amends Section 2 of Article 25-A of the Oklahoma
Constitution. It would remove the prohibition against enacting
additional restrictions on eligibility for Medicaid.
Additionally, if federal funding for the Medicaid expansion
population drops below 90%, this measure will repeal Sections 1,
2, 3, and 4 of Article 25-A of the Oklahoma Constitution and
will enact substantially the same language related to Medicaid
expansion from the repealed constitutional provisions into the
Oklahoma Statutes. The statutes could be amended, repealed, or
otherwise modified by the Legislature pursuant to the same
procedures that allow enactment of laws during any regular or
extraordinary session of the Legislature.
SHALL THE PROPOSAL BE APPROVED?
FOR THE PROPOSAL — YES _____________
AGAINST THE PROPOSAL — NO _____________
SECTION 7. The Chief Clerk of the House of Representatives
shall, immediately after the passage of this act, prepare and file
one copy thereof, including the Ballot Title set forth in SECTION 6
hereof, with the Secretary of State and one copy with the Attorney
General.”
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Passed the Senate the 14th day of April, 2026.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of __________,
2026.
Presiding Officer of the House
of Representatives
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ENGROSSED HOUSE
BILL NO. 4440 By: Hilbert and Lepak of the
House
and
Paxton of the Senate
An Act relating to public health and safety;
ordering a legislative referendum pursuant to the
Oklahoma Constitution to amend the Oklahoma
Constitution by repealing Sections 1, 2, 3 and 4 of
Article XXV-A; ordering a legislative referendum;
providing for enactment of statutes
related to Medicaid and Medicaid expansion; defining
terms; requiring certain medical services be made
available to certain persons; imposing duty on
Oklahoma Health Care Authority; providing ballot
title; ordering a special election; and directing
filing.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 8. The Secretary of State shall refer to the people for
their approval or rejection, as and in the manner provided by law,
the following proposed amendment to the Constitution of the State of
Oklahoma by repealing Sections 1, 2, 3 and 4 of Article XXV-A of the
Oklahoma Constitution.
SECTION 9. Pursuant to Section 3 of Article V of the Oklahoma
Constitution, there is hereby ordered the following legislative
referendum which shall be filed with the Secretary of State and
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addressed to the Governor of the state, who shall submit the same to
the people for their approval or rejection at the election to be
conducted on August 25, 2026.
SECTION 10. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7401 of Title 63, unless there
is created a duplication in numbering, reads as follows:
As used in this act:
1. "Centers for Medicare and Medicaid Services" or "CMS" refers
to the agency responsible for administering the Medicaid program at
the federal level, including review and approval of State Plan
Amendments;
2. "Low-income adults" refers to those individuals over age
eighteen (18) and under age sixty-five (65) whose income does not
exceed one hundred thirty-three percent (133%) of the federal
poverty level, as described by and using the income methodology
provided in the federal Medicaid statute at 42 U.S.C., Section
1396a(a)(10)(A)(i)(VIII), and who meet applicable nonfinancial
eligibility conditions for Medicaid under 42 CFR, Part 435, Subpart
E;
3. "Medical assistance" means payment of part or all of the
cost of the care and services, or the care and services themselves,
or both, as provided in the federal Medicaid statute, 42 U.S.C.
Section 1396 et seq.;
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4. "Oklahoma Health Care Authority" refers to the single state
agency responsible for administering the Oklahoma Medicaid program
pursuant to 42 U.S.C., Section 1396a(a)(5); and
5. "State Plan Amendment" refers to the document(s) the state
submits to the Centers for Medicare and Medicaid Services for review
and approval before making a change to its program policies,
including setting forth the groups of individuals to be eligible for
medical assistance.
SECTION 11. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7402 of Title 63, unless there
is created a duplication in numbering, reads as follows:
In addition to those otherwise eligible for medical assistance
under Oklahoma's Medicaid program, the state shall provide medical
assistance under Oklahoma's Medicaid program to low-income adults.
SECTION 12. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7403 of Title 63, unless there
is created a duplication in numbering, reads as follows:
The Oklahoma Health Care Authority shall take all actions
necessary to maximize federal financial participation in funding
medical assistance pursuant to this act.
SECTION 13. The Ballot Title for the proposed Constitutional
amendment repealing Sections 1, 2, 3 and 4 of Article XXV-A of the
Oklahoma Constitution and the enactment of statutory provisions
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related to Medicaid as set forth in Sections 2 through 5 of this
measure shall be in the following form:
BALLOT TITLE
Legislative Referendum No. ____ State Question No. ____
THE GIST OF THE PROPOSITION IS AS FOLLOWS:
This measure proposes an amendment to the Oklahoma Constitution
by repealing Sections 1, 2, 3 and 4 of Article 25-A, and it also
proposes the enactment of substantially the same language from
those constitutional sections as statutes. If this question
passes, then the sections from the Oklahoma Constitution would
be repealed, but the substantive language related to Medicaid
from the constitutional sections would become enacted as
statutes of the State of Oklahoma. The statutes could be
amended, repealed, or otherwise modified by the Legislature
pursuant to the same procedures that allow enactment of laws
during any regular or extraordinary session of the Legislature.
SHALL THE PROPOSAL BE APPROVED?
FOR THE PROPOSAL — YES _____________
AGAINST THE PROPOSAL — NO _____________
SECTION 14. A special election is hereby ordered to be held
throughout the State of Oklahoma on the date of August 25, 2026, at
which time the proposed amendment to the Constitution of the State
of Oklahoma, as set forth in SECTION 1 of this act, shall be
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submitted to the people of Oklahoma for their approval or rejection
as and in the manner provided by law.
SECTION 15. The Chief Clerk of the House of Representatives,
immediately after the passage of this measure, shall prepare and
file one copy thereof, including the Ballot Title set forth in
SECTION 6 hereof, with the Secretary of State and one copy with the
Attorney General.
Passed the House of Representatives the 25th day of March, 2026.
Presiding Officer of the House
of Representatives
Passed the Senate the ___ day of __________, 2026.
Presiding Officer of the Senate