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HB 1423

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 3 co-sponsors

Texas bill would expand Medicaid to cover 1+ million low-income adults under the ACA's optional expansion, requiring 10% state funding match with 90% federal coverage.

Referred to Appropriations
#health&humanservicescommission(v0177) #humanservices--medicalassistance(i0905) #medicaid(s4885)
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Bill Summary · HB 1423

Legislative bill overview

HB 1423 would 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, which covers adults earning up to 138% of the federal poverty line. This bill seeks to bring Texas into alignment with the 40+ states that have already implemented this expansion.

Why is this important

Texas has the second-largest uninsured population in the nation, with approximately 3.6 million uninsured residents. Medicaid expansion would provide health coverage to an estimated 1+ million Texans currently ineligible under the state's restrictive income thresholds, potentially improving health outcomes and reducing uncompensated care costs for hospitals. The federal government covers 90% of expansion costs indefinitely under the ACA, though Texas would bear 10% of the expense.

Potential points of contention

  • Fiscal responsibility debate: Critics argue Texas cannot afford the state's 10% share (~$1.5-2 billion annually long-term), while supporters counter that federal funding and reduced uncompensated care costs offset state expenses
  • Ideological opposition: Some legislators oppose expansion on principle as federal overreach, while proponents view it as pragmatic use of available federal funds
  • Implementation complexity: Questions remain about integrating expansion populations into existing program infrastructure and managing enrollment surges

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

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