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, Subchapter H, to Chapter 32 of the Human Resources Code, which mandates that the 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 to assess the impact of this expansion on various factors, including the number of uninsured individuals and state healthcare costs.

The bill stipulates that the new eligibility criteria will only apply to initial determinations or recertifications made on or after January 1, 2026. Furthermore, the implementation of this act is contingent upon the approval of a constitutional amendment by voters in the 89th Legislature, Regular Session, 2025, which would require the state to expand Medicaid eligibility as outlined. If the amendment is not approved, the act will have no effect.

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