H.B. No. 2604 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. The bill also requires an annual report to be submitted by December 1 each year, detailing the impact of the expanded eligibility on various health care costs and the number of uninsured individuals in the state.

The implementation of this expanded eligibility is contingent upon the approval of a constitutional amendment by voters in the 2025 election. If approved, the new eligibility criteria will apply to determinations made on or after January 1, 2026. The bill allows for a delay in implementation if necessary federal waivers are required, and it stipulates that the first report on the effects of the expansion will not be due until December 1, 2026.

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