H.B. No. 1355 proposes an expansion of Medicaid eligibility in Texas, aligning with the federal Patient Protection and Affordable Care Act. The bill introduces a new Subchapter H to Chapter 32 of the Human Resources Code, which mandates that the commission provide medical assistance to all individuals who apply and qualify for federal matching funds under the Affordable Care Act. Additionally, the executive commissioner is tasked with adopting rules to facilitate this provision. The bill also requires an annual report to key state officials on the impacts of this expanded eligibility, focusing on metrics such as the number of uninsured individuals, state and local healthcare costs, and charity care expenses.

The provisions of this bill will only apply to initial determinations or recertifications of eligibility made on or after January 1, 2026, regardless of when the application is submitted. The executive commissioner is instructed to take necessary actions to implement this expansion, including notifying federal agencies, and may delay implementation if additional waivers or authorizations are required. The bill is set to take effect on January 1, 2026.

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