TX HB1903

Authorizes the Health and Human Services Commission to administer Texas Medicaid under a block grant funding system if the federal government establishes or approves such an arrangement, using a risk-based managed care model

Establishes Medicaid acute care eligibility for individuals with household income at or below 100% of the federal poverty level, children 18 and under receiving SSI or in foster care, and those meeting eligibility requirements as of August 31, 2025

Creates sliding scale premium subsidies for eligible Medicaid recipients to purchase private health insurance, with enhanced subsidies for those choosing high-deductible health plans with health savings accounts

Establishes a separate program for individuals ages 64 and younger with household income at or below 133% of the federal poverty level who are not otherwise Medicaid-eligible, providing premium assistance to purchase private market health coverage

Requires the Commission to negotiate with federal authorities for waivers to use federal matching funds, with any agreement required to be cost-neutral to Texas through premium tax revenues and cost savings mechanisms

Takes effect September 1, 2025, with implementation contingent on obtaining necessary federal waivers or authorizations