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 to state leadership detailing the impacts of this expanded eligibility on health coverage, state and local healthcare costs, and charity care expenses.

The implementation of this expanded eligibility is contingent upon the approval of a constitutional amendment by Texas voters, which is set to be proposed during the 89th Legislature's Regular Session in 2025. If approved, the new eligibility criteria will take effect on January 1, 2026, and the commission will not be required to submit its first report on the effects of this expansion until December 1, 2026. The bill emphasizes the need for the executive commissioner to take necessary actions to notify federal agencies and secure any required waivers before the expansion can be fully implemented.

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