H.B. No. 1423 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 Health and Human Services 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 impact of this expanded eligibility on various health care metrics, including the number of uninsured individuals and associated state and local health care costs.

The implementation of this expanded eligibility is contingent upon the approval of a constitutional amendment proposed by the 89th Legislature, which must be approved by voters. If the amendment is approved, the new eligibility criteria will take effect on January 1, 2026, specifically for initial determinations or recertifications of eligibility made on or after that date. The bill also allows for a delay in implementation if necessary federal waivers or authorizations are required.

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