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HB 1355

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 John Bryant and 2 co-sponsors

HB 1355 would expand Texas Medicaid to cover low-income adults under ACA guidelines, potentially insuring 600,000+ additional residents using 90% federal funding.

Referred to Appropriations
#health&humanservicescommission(v0177) #humanservices--medicalassistance(i0905) #medicaid(s4885)
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Bill Summary · HB 1355

Legislative bill overview

HB 1355 proposes expanding Texas Medicaid eligibility to include individuals who would qualify under the federal Affordable Care Act's optional expansion provisions. Currently, Texas has not adopted the ACA's Medicaid expansion, which would cover adults earning up to 138% of the federal poverty level. This bill would bring Texas into alignment 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 3.6 million uninsured residents. Medicaid expansion could provide health coverage to roughly 600,000-900,000 additional low-income Texans, improving healthcare access and potentially reducing uncompensated care costs for hospitals. The federal government currently covers 90% of expansion costs, making it a significant fiscal opportunity for the state.

Potential points of contention

  • Fiscal responsibility debate: Opponents argue expansion strains state budgets long-term despite federal matching funds; supporters contend the 10% state cost is offset by reduced emergency department usage and improved public health outcomes
  • Federal funding sustainability: Questions remain about whether the federal government will maintain its 90% funding commitment indefinitely, creating potential future liability for Texas
  • Philosophical disagreement on government's role: Conservatives view expansion as government overreach; progressives see it as a moral obligation to provide healthcare access to vulnerable populations
  • Impact on private insurance and work incentives: Debate exists over whether expansion discourages workforce participation or simply extends coverage to those unable to work full-time jobs with benefits

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

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