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 for the implementation of this expanded eligibility. An annual report is also required, detailing the effects of this expansion on health coverage, state and local healthcare costs, and charity care.

The provisions of this bill will take effect on January 1, 2026, contingent upon the approval of a constitutional amendment by voters that mandates the state to expand Medicaid eligibility. The initial determination or recertification of eligibility under the new rules will only apply to applications made on or after this date. Furthermore, the commission is not obligated to submit the first report on the effects of the expansion until December 1, 2026, allowing for a delay in implementation if necessary federal waivers are required.

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