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In Oklahoma, the Medicaid vote occurred against a complicated backdrop. The state is the only one so far that had taken the Trump administration up on an offer to abandon the program’s traditional status as a federal entitlement, in which each state is paid a fixed amount for each person who qualifies. Instead, the administration has said it is willing to free states from a lot of federal rules if they switch to a per person cap or a block grant, in which a state’s federal money would be fixed in times of economic crisis, such as a pandemic, when more people would qualify.

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