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Budget Break Down by Sen. Roger Thompson, Senate Appropriations Chair

When you look at Oklahoma’s budget, it’s a little over $7.8 billion.  While many people are probably aware the lion’s share of that goes to education, they may not realize that health care is the second highest expense.  It makes up 31 percent of the total budget—some $2.3 billion in fiscal year 2021. This week, I want to break down where those funds go.

The Oklahoma Health Care Authority (OHCA) administers Medicare and Medicaid for the state, and they received a little over $1 billion.  With that, we also pull down another $5 billion in matching dollars from the feds.  So how many people are we currently serving with those funds?  As of this past August, the enrollment was 893,262 people, and most of those, 65 percent, were children.  It’s also important to note this is an all-time high figure.  We’ve seen an increase of over 111,000 since January, which can be attributed to Oklahomans losing their jobs during the pandemic.  Just since July, 926,984 Oklahomans have been served by OHCA—that’s 23 percent of the total state population.

Another area that will undoubtedly be impacted by COVID-19 will be mental health.  The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) received almost $335 million in state dollars.  Last fiscal year, almost 197,000 Oklahomans were served by this agency, which includes more than 31,000 people who received substance abuse services and more than 182,000 who received mental health services.

The Oklahoma State Department of Health (OSDH) is another vital component of our state’s health care system, and it too has been in the news as a result of the pandemic.  Their state appropriation is $57.8 million.  The Oklahoma Department of Veterans Affairs (ODVA) has 1,014 veterans living in its seven centers and receives $33.3 million.  The JD McCarty Center received $4.7 million and treated 7,735 children with disabilities in fiscal year 2020.

Having access to doctors, particularly in rural communities, is of tremendous importance to improve health outcomes.  In FY ‘20, we appropriated $45.4 million to the Oklahoma State University Medical Authority and Trust (OSUMA), which filled 352 residency slots.  The University Hospitals Authority and Trust (OHA) at OU received $66.6 million, filling 759 residency slots.  This is very important for Oklahoma, because where doctors are trained is usually where they practice.  But up until a couple of years ago, we had a waiver that allowed us to use some Medicaid dollars to train residents.  That’s no longer the case—this is an additional $100 million now that we didn’t have to appropriate before.

Certainly, coming up with that additional money has been a challenge, but we have an even greater challenge in the next budget year.  The people of Oklahoma voted to expand Medicaid. Bringing in additional federal dollars is a great thing, and we want our state to be healthier.  But as Appropriations chair, I’m faced with the question, how will we pay for that expansion?  It’s estimated it could cost us from $164 million to $256 million in additional state dollars even as we continue to address the impact of the pandemic and low energy prices on state revenues.   We certainly have our work cut out for us, but at the end of the day, we will fulfill our constitutional mandate to write and pass a balanced budget.

Contact info

If you have any questions about the budget or the appropriations process, I invite you to contact me at 405-521-5588 or email