The bill, H.B. No. 2604, proposes an expansion of Medicaid eligibility in Texas to include all individuals who apply for medical assistance and for whom federal matching funds are available under the Patient Protection and Affordable Care Act (ACA). It introduces a new Subchapter H to Chapter 32 of the Human Resources Code, which outlines the expanded eligibility provisions. The executive commissioner of the Health and Human Services Commission is tasked with adopting rules for the implementation of this expanded eligibility. Additionally, the bill mandates an annual report to key state officials on the effects of this expansion, including its impact on the uninsured population, state and local healthcare costs, and charity care expenses.

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 provisions of the bill will take effect on January 1, 2026, and the initial determination of eligibility will apply to cases initiated on or after that date. Notably, the commission is not required to submit the first report on the effects of the expanded eligibility until December 1, 2026.

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