The bill, S.B. No. 45, proposes an expansion of Medicaid eligibility in Texas to include individuals who qualify for medical assistance under the federal Patient Protection and Affordable Care Act (ACA). It introduces a new Subchapter H to Chapter 32 of the Human Resources Code, which mandates that the Texas Health and Human Services Commission provide medical assistance to all applicants eligible for federal matching funds under the ACA. Additionally, the executive commissioner is required to adopt rules for the implementation of this expanded eligibility. An annual report is also mandated, detailing the effects of this expansion on health coverage, state and local healthcare costs, and charity care.

The provisions of this bill will only apply to eligibility determinations made on or after January 1, 2026, and the bill's effectiveness is contingent upon the approval of a constitutional amendment by voters in the 2025 Regular Session. If the amendment is not approved, the bill will have no effect. The bill emphasizes the need for the executive commissioner to take necessary actions to implement the expansion, including seeking any required federal waivers or authorizations.

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