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. An annual report is also required, detailing the impacts of this expanded eligibility on 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. Following the bill's effective date, the executive commissioner must take necessary actions to implement the expanded eligibility, including notifying federal agencies. If any federal waivers or authorizations are needed for implementation, the state agency may delay the process until such approvals are obtained.

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