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SB 255

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 Carol Alvarado and 5 co-sponsors

SB 255 expands Texas Medicaid eligibility to 138% federal poverty level, covering ~650K uninsured adults using 90% federal funding while requiring 10% state expenditure.

Referred to Health & Human Services
#health&humanservicescommission(v0177) #humanservices--medicalassistance(i0905) #medicaid(s4885)
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Bill Summary · SB 255

Legislative bill overview

SB 255 proposes expanding Texas Medicaid eligibility to include individuals who qualify under the federal Affordable Care Act's Medicaid expansion provisions. This would align Texas with the optional federal expansion that allows states to cover adults earning up to 138% of the federal poverty level, which Texas has not yet adopted. The bill addresses a coverage gap affecting hundreds of thousands of uninsured Texans who fall between current eligibility limits and marketplace insurance thresholds.

Why is this important

Texas is one of 12 states that has not expanded Medicaid, leaving approximately 650,000 adults without access to state-funded coverage. Expansion would reduce uninsured rates, potentially improve health outcomes for low-income residents, and shift some healthcare costs from emergency services to preventive care. The federal government currently covers 90% of expansion costs, though Texas would assume the remaining 10%—a significant state budget consideration.

Potential points of contention

  • State budget impact: Texas would need to allocate state funds (approximately 10% of costs) in a state with constitutional balanced-budget requirements and competing budget priorities
  • Work requirements and program structure: Disagreement over whether expansion should include work requirements or other eligibility conditions that differ from federal ACA standards
  • Ideological divide: Long-standing Texas political opposition to federal healthcare mandates and concerns about government dependency versus arguments for federal funding efficiency and improved public health

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

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