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Bill

SB 45

Relating to the expansion of eligibility for Medicaid to certain individuals under the federal Patient Protection and Affordable Care Act.

89th Legislature (2025) Introduced by César Blanco and 1 co-sponsor

Expands Texas Medicaid to cover low-income adults earning under 138% of poverty line, extending health insurance to approximately 1.5 million currently uninsured residents with 90% federal funding.

Co-author authorized
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Bill Summary · SB 45

Legislative bill overview

SB 45 proposes to expand Texas Medicaid eligibility to include individuals who qualify under the federal Affordable Care Act's optional expansion provisions. Currently, Texas has not adopted the ACA's Medicaid expansion, leaving a coverage gap for working-age adults earning between 100-138% of the federal poverty line. This bill would align Texas with the 40+ states that have already implemented this expansion.

Why is this important

Texas has the second-highest uninsured rate in the nation, with approximately 3.7 million uninsured residents. Medicaid expansion would provide health coverage to an estimated 1.5 million additional low-income Texans, potentially improving health outcomes and reducing uncompensated care costs in hospitals. The federal government currently covers 90% of expansion costs, with Texas covering 10%, making it a financially supported option for state policymakers.

Potential points of contention

  • State budget impact: While federally subsidized at 90%, Texas would still bear ongoing costs (10%) estimated at $1+ billion annually, raising concerns about long-term state budget commitments and potential future federal funding reductions
  • Conservative ideology: Texas leadership has traditionally opposed Medicaid expansion on principle, viewing it as federal overreach and preferring market-based healthcare solutions over government expansion
  • Implementation complexity: Significant administrative burden to enroll and maintain eligibility for 1.5+ million new beneficiaries across state systems

Compiled from official sources — confirm details with the bill’s official record.

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