Mental health policy changes from Oklahoma’s 2026 legislative session

Lawmakers made some meaningful mental health strides this year — like a $5.9 million appropriation to sustain 988 operations for another year, and a bill that will allow peers and case managers to bring their skills to important, novel roles.

Despite this progress, lawmakers left some behavioral health opportunities on the table in a legislative session hampered by tension between lawmakers around other issues and an early adjournment.

These opportunities include strategic, data-driven proposals — like securing sustainable funding for 988 and ensuring fair standards for behavioral health care through insurance — that would help lawmakers use Oklahoma’s limited resources wisely while making it easier for Oklahomans to get the help they need. Legislators will have an opportunity to consider these ideas in future sessions.

In the meantime, health care conversations at the Capitol were dominated by concerns over costs — especially Medicaid costs — as lawmakers wrestled with budget woes at the state Health Care Authority. In addition, the Legislature did not reach consensus on controversial proposals that would have asked voters to allow legislators to alter Medicaid expansion and to “reset” the Tobacco Settlement Endowment Trust from funding health to funding higher education.

Our recap of the 2026 legislative session highlights the bills that made it past the finish line and their impact on Oklahoma's mental health landscape.

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• Healthy Minds' priorities
• Missed opportunities for behavioral health
• ODMHSAS's future and finances
• Revisiting Medicaid expansion
• Other key mental health bills

Healthy Minds' priorities

Since 2020, Healthy Minds has worked with lawmakers to draft and pass over a dozen critical bills to support Oklahomans’ access to mental health care. This year, two of our top priorities made it past the finish line:

A lifeline for 988

SB 1164, an ODMHSAS budget bill by Sen. Rob Hall (R-Perry), Sen. John Haste (R-Broken Arrow), Rep. Trey Caldwell (R-Lawton), and Rep. John Kane (R-Bartlesville), included a $5.9 million appropriation to keep the 988 Suicide and Crisis Lifeline operational in Oklahoma after its current funding will expire later this year. This is a single-year appropriation; lawmakers will have to revisit 988 funding for 2027 and beyond.

Other 988-related bills introduced this session were HB 4092 and SB 1369, which shared the same language and were authored by Sen. Brenda Stanley (R-Midwest City) and Rep. Kevin Norwood (R-Owasso). These bills would have created a pathway for sustainable 988 funding — beyond just a single-year appropriation — by establishing a revolving fund, in addition to outlining policies detailing crisis services provided through 988, but both stalled and did not become law.

Expanding the reach of peers and case managers

HB 4275 by Rep. Nicole Miller (R-Edmond) and Sen. Aaron Reinhardt (R-Jenks) will allow peer recovery support specialists and behavioral health case managers to work for municipalities, counties, and organizations certified by the ODMHSAS while still maintaining their certification, allowing them to serve in important roles in fire departments, courts, and other settings.

Previously, peers and case managers could only keep their certification through employment with certain entities, which limited their opportunities to serve communities in novel roles, like as court navigators or on alternative response teams.

Missed opportunities for behavioral health

Healthy Minds’ priority bills highlighted opportunities to shift behavioral health costs upstream and use the state’s limited health care resources more effectively long-term. Lawmakers in 2027 should revisit these policy opportunities, all of which had wide bipartisan support and advanced through three-quarters of the legislative process in 2026:

Establishing fair standards for behavioral health care coverage

Insurance companies have significant power to determine the type of behavioral health care a person receives and what it costs. But many insurers make these life-changing determinations using vague and arbitrary standards for coverage that often conflict with evidence-based clinical guidelines.  

Related: How ‘generally accepted standards of care’ create fairer systems for accessing behavioral health treatment

SB 1646 by Sen. Todd Gollihare (R-Kellyville) and Rep. Mark Lawson (R-Sapulpa) would have required commercial insurers to follow “generally accepted standards of care” when making decisions about whether to cover mental health and substance use service or treatments. This policy change would have grounded insurers’ behavioral health care decisions in the guidance of behavioral health experts — not just cost or convenience.

Sustainable funding for 988

Oklahoma must find a long-term solution to secure the future of 988. While lawmakers did appropriate another year of funding for 988, this will only cover local call centers’ operations for one year.

When people call 988 in Oklahoma, they get help from Oklahoma-based call-takers who understand the state’s systems, services, and pathways for mental health and substance use care. This is a life-saving service, and Oklahoma needs a stable funding source for it.

HB 4092 and SB 1369, mentioned above, were opportunities to sustain 988 funding long-term, but neither became law.

Next session, lawmakers should work to secure ongoing funding for 988 similar to how the state funds 211, Oklahoma’s hotline for community resources. For example, this year legislators passed SB 1290 and HB 4095, both by Sen. Jo Anna Dossett and Rep. Norwood, which outlined policies for 211 and created a revolving fund for the hotline.

Strengthening court-ordered outpatient treatment as a jail diversion tool

The court system provides needed structure and a framework for how the civil and criminal legal system address serious mental illness, but gaps and a lack of clarity of expectations risks program success and risks the protection of individual rights.

HB 3587 by Rep. Erick Harris (R-Edmond) and Sen. Todd Gollihare (R-Kellyville) clarifies and improves processes and procedures around court-ordered outpatient treatment so that this diversion tool can be used more consistently and reliably across Oklahoma. HB 3587 received 100 votes throughout the legislative process, but was not heard on the Senate floor. As the state seeks solutions address mental health and substance use crises, clear legal pathways are critical.

ODMHSAS's future and finances

After last year’s confusing financial picture, lawmakers kept tabs again on the Oklahoma Department of Mental Health and Substance Abuse Services this session.

With the department’s finances still not fully ironed out, lawmakers passed SB 1177 allocating funds to cover gaps from last fiscal year and maintain comparable funding for the next fiscal year.

In total, the bill appropriated nearly $385.5 million in funding for FY 2027, including:

• $4.5 million for the Mental Health Transportation Revolving Fund, which is funding reserved for transporting individuals to the nearest facility for an initial mental health assessment or treatment, and
• $12.5 million to the County Community Safety Investment Fund, which directs money to counties for programs and strategies that divert people from the criminal justice system and connect them with behavioral health treatment

Meanwhile, policymakers are weighing whether to move ODMHSAS under the purview of the Oklahoma State Department of Health. The health department’s budget bill (SB 1162) included a $1 million line item to work with a financial expert to monitor and report on ODMHSAS’s financial wellbeing.

Further, SB 1572, by Sen. Paul Rosino (R-Oklahoma City) and Rep. Preston Stinson (R-Edmond) proposed a feasibility study on potential consolidation of the health and mental health departments. That bill is still awaiting action by the governor, who has until May 28 to sign.

Last, Rear Admiral Gregory Slavonic’s time as ODMHSAS’s interim commissioner ended when the session adjourned. Another interim commissioner is expected to fill the role until a permanent commissioner is appointed by Oklahoma’s next governor, whom voters will elect in November.

Revisiting Medicaid expansion

Lawmakers spent much of their energy on concerns about paying for Medicaid expansion should the federal match for the program fall below its current level.

In 2020, voters passed State Question 802, which extended Medicaid eligibility to low-income adults through an addition to the state’s constitution. Currently, the federal government pays for 90% of the cost of health care for the expansion population — this is called the Federal Medical Assistance Percentage, or FMAP. The state is responsible for the other 10%.

Because Oklahoma Medicaid expansion is enshrined in the constitution rather than in state statute, state lawmakers cannot alter the program without voters’ approval. Oklahoma is one of only three states that embedded Medicaid expansion into its constitution.

This year, lawmakers filed several bills — including HB 4063, HB 4440, HJR 1067,  HJR 1077, and SJR 50 — that would have asked Oklahoma voters to shift Medicaid expansion out of the state constitution and into state statute. This would allow lawmakers to adjust the program if, for example, the federal government match changed.

Lawmakers’ attempts to put the question on a ballot in August or November both failed. While it won’t appear on a ballot this year, lawmakers will likely keep pressing the issue during interim legislative studies this fall and into next year’s session.

Other key mental health bills

Criminal justice

• Use of medication in the competency restoration process: HB 2137 by Rep. Stinson and Sen. Adam Pugh (R-Edmond) outlines procedures for administering medication as part of the competency restoration process for someone who cannot consent to treatment because of a severe behavioral health condition. When someone is deemed “incompetent” in a criminal proceeding, it means the person lacks the ability to understand the charges brought against them or help with their own defense. Many people can regain competency with education, medication, or treatment.
  

Related: Understanding the competency evaluation and restoration process for Oklahoma criminal defendants

• Broader eligibility for drug court programs: SB 1216 by Sen. Dave Rader (R-Tulsa) and Rep. Erick Harris (R-Edmond) removes the requirement of someone to have a felony charge to participate in drug treatment court programs. After voters approved State Questions 780 and 781 in 2016, reclassifying many non-violent drug and property offenses as misdemeanors, treatment court participation declined. SB 1216 expands eligibility so that more people will be able to participate in treatment court as an alternative to prosecution.

Health care and insurance

• Specifications around mental health care directives: HB 1687 by Rep. Cynthia Roe (R-Lindsay) and Sen. Rosino creates the Uniform Health Care Decisions Act of 2026, which allows people to make advance health care directives specific to their mental health care. These advance directives can include language about treatment preferences for mental health conditions and offer people the opportunity to state their wishes before they are in a mental health crisis, for example.
• Deadline to set minimum reimbursement rates: HB 3650 by Rep. Stinson and Sen. Rosino extends the deadline for the Oklahoma Health Care Authority to establish minimum provider reimbursement rates (often called rate floors) until July 1, 2028. When rate floors expire, providers often face lower reimbursement rates.

Opioid and substance use

• First responder overdose reporting: HB 2941 by Rep. Steve Bashore (R-Miami) and Sen. Reinhardt requires first responders to notify law enforcement when they respond to suspected overdoses, after attending to the person’s medical needs. First responders who make the notification in good faith are shielded from any civil or criminal liability related to the response.
• Legal protections around naloxone: SB 65 by Sen. Darrell Weaver (R-Moore) and Rep. Tim Turner (R-Kinta) says that anyone can acquire, store, and administer emergency opioid antagonists like naloxone — sometimes referred to as Narcan — without fear of criminal prosecution or civil liability.

Behavioral health workforce

• Rural workforce development: HB 3066 by Rep. Ellen Pogemiller (D-Oklahoma City) and Sen. Seifried creates the Rural Health Transformation Revolving Fund for the Health Care Workforce Training Commission to recruit and retain clinical professionals in the rural and underserved areas of Oklahoma.

Related: Behavioral health strategies for Oklahoma’s application for critical Rural Health Transformation Fund dollars

• Statewide inpatient capacity registry: SB 1794 by Sen. Stanley and Rep. Roe requires ODMHSAS to establish and maintain a statewide behavioral health vacancy registry with real-time information on bed availability and capacity at treatment facilities. It also seeks to expedite bed placements associated with emergency detention, protective custody, and court-ordered competency evaluations and competency restoration services.