No state agency is working on building a health care exchange at this point, said Alex Weintz, Fallin's communications director.
Oklahoma lawmakers don't meet again until February, and the governor said she has no intention of calling them back for a special session.
“It's always a possibility, but it's not something I'm going to do,” she said.
Democrats criticized the blase attitude of GOP leaders.
“For purely political purposes, Gov. Fallin flip-flopped on her decision to accept federal dollars for the state exchange, which at the time she said we were lucky to receive,” said Rep. Mike Brown, D-Tahlequah. “She refused these dollars and refrained from making any other effort to be in federal compliance. So here we are now — our state is short $54 million and Gov. Fallin has egg on her face.
“Gov. Fallin and Republican leadership gambled that the Supreme Court would overturn the Affordable Care Act, and did nothing in the meantime, which in my opinion amounts to a dereliction of duty to the people of Oklahoma,” Brown said.
Oklahoma Democratic Party Chairman Wallace Collins said, “It is immoral for the Republican leadership to gamble with the lives of our citizens and now they should start helping restore Oklahoma.”
Fallin said it wasn't a mistake for Oklahoma to turn down the $54.6 million federal grant.
The high court ruling also limited how the federal government could punish states that don't comply with its Medicaid regulations.
The federal health care law included expanding Medicaid eligibility up to 133 percent of the federal poverty level.
Mike Fogarty, chief executive officer of the Oklahoma Health Care Authority, which manages the state's Medicaid programs, said the Supreme Court ruled that states have a choice whether to cover additional people through their Medicaid programs.
“We expect the federal government will issue additional guidance as this ruling is reviewed,” he said. “The Oklahoma Health Care Authority will look toward Oklahoma's leadership for direction as to future action.”
Expanding Oklahoma's SoonerCare program under the federal guidance would make health care benefits available to an estimated 200,000 newly qualified adults, aged 19 to 64, with household incomes at or below 133 percent of the federal poverty level, Fogarty said. A single adult could make up to $15,414 a year, or a family of three would qualify with a household income at or below $26,344.
Medicaid benefits now are available to most Oklahomans with household incomes at or below 37 percent of the federal poverty level, said Jo Kilgore, a Health Care Authority spokeswoman. A family of four has to have an income of less than roughly $8,000 to qualify, she said.
The federal government currently pays for about 64 percent of the SoonerCare and Insure Oklahoma programs, or about $3.25 billion of the total $5.2 billion budget for this fiscal year, Fogarty said. In this fiscal year, SoonerCare and Insure Oklahoma has provided health care benefits to more than 990,000 Oklahomans.
The new eligibility rates are to take effect Jan. 1, 2014. If the state chooses to expand SoonerCare in 2014, the first three years of benefits for the new population would be paid completely by the federal government.
Beginning in 2017, the federal government's share would be 95 percent and would taper to 90 percent in 2020, Fogarty said.
About 17 percent of Oklahomans, or nearly 625,000, are uninsured, Kilgore said. Expanding the Medicaid eligibility up to 133 percent of the federal poverty level would have cut that number of uninsured nearly in half, or by about 250,000, according to Health Care Authority estimates.