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Bill

SB 638

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

89th Legislature (2025)

SB 638 expands Texas Medicaid eligibility under ACA provisions, potentially covering 800,000+ low-income uninsured adults through federal and state funding partnerships.

Referred to Health & Human Services
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Bill Summary · SB 638

Legislative bill overview

SB 638 proposes to expand Texas Medicaid eligibility to align with provisions available under the federal Affordable Care Act (ACA). The bill would extend coverage to individuals who currently fall outside Texas's more restrictive eligibility requirements, likely targeting adults earning between 100-138% of the federal poverty level—a group the ACA allows states to cover but Texas has historically excluded.

Why is this important

Medicaid expansion directly affects healthcare access for approximately 800,000-1 million low-income Texans currently uninsured. The decision also carries significant budgetary implications, as the federal government covers 90% of expansion costs initially, with Texas eventually responsible for 10%—estimated at $1-2 billion annually once full state obligations begin.

Potential points of contention

  • State fiscal responsibility: While federal funding is generous initially, long-term state budget commitments could strain other priorities or require tax increases
  • Work requirement debates: Conservative legislators may seek to impose work mandates on recipients, while advocates argue this creates barriers for disabled individuals and caregivers
  • Federal funding reliability: Concerns about potential federal funding changes or political shifts affecting future reimbursement levels

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

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