HB 2604

relating to the expansion of eligibility for Medicaid to certain
individuals under the federal Patient Protection and Affordable
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Chapter 32, Human Resources Code, is amended by
adding Subchapter H to read as follows:
SUBCHAPTER H.  EXPANSION OF ELIGIBILITY FOR MEDICAL ASSISTANCE
Sec. 32.351.  EXPANDED ELIGIBILITY FOR MEDICAL ASSISTANCE
UNDER PATIENT PROTECTION AND AFFORDABLE CARE ACT.  (a)
Notwithstanding any other law, the commission shall provide medical
assistance to all individuals who apply for that assistance and for
whom federal matching funds are available under the Patient
Protection and Affordable Care Act (Pub. L. No. 111-148), as
amended by the Health Care and Education Reconciliation Act of 2010
(Pub. L. No. 111-152), to provide that assistance.
(b)  The executive commissioner shall adopt rules regarding
the provision of medical assistance as required by this section.
Sec. 32.352.  ANNUAL REPORT ON EXPANDED ELIGIBILITY FOR
MEDICAL ASSISTANCE.  Not later than December 1 of each year, the
commission shall report to the governor, the lieutenant governor,
the speaker of the house of representatives, and each member of the
legislature on the effects of expanding eligibility for medical
assistance under Section 32.351, including the effects on:
(1)  the number of individuals in this state who do not
(2)  state health care costs, including costs relating
to programs funded with money appropriated out of the general
(3)  local health care costs; and
(4)  charity care and uncompensated care costs for
SECTION 2.  Section 32.351, Human Resources Code, as added
by this Act, applies only to an initial determination or
recertification of eligibility of an individual for medical
assistance under Chapter 32, Human Resources Code, made on or after
January 1, 2026, regardless of the date the individual applied for
SECTION 3.  As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall take all necessary actions to expand
eligibility for medical assistance under Chapter 32, Human
Resources Code, in accordance with Section 32.351, Human Resources
Code, as added by this Act, including notifying appropriate federal
agencies of that expanded eligibility.  If before implementing any
provision of this Act a state agency determines that any other
waiver or authorization from a federal agency is necessary for
implementation of that provision, the agency affected by the
provision shall request the waiver or authorization and may delay
implementing that provision until the waiver or authorization is
SECTION 4.  Notwithstanding Section 32.352, Human Resources
Code, as added by this Act, the commission is not required to submit
the initial report required by that section until December 1, 2026.
SECTION 5.  This Act takes effect January 1, 2026, but only
if the constitutional amendment proposed by the 89th Legislature,
Regular Session, 2025, requiring the state to expand eligibility
for Medicaid to all individuals for whom federal matching funds are
available under the federal Patient Protection and Affordable Care
Act is approved by the voters.  If that amendment is not approved by
the voters, this Act has no effect.