TX SB289

Establishes a framework for Texas to operate its Medicaid program under a federal block grant funding system if authorized, providing acute care benefits through risk-based managed care for individuals at or below 100% of the federal poverty level

Creates a "private market solutions" program to provide premium assistance and health coverage for low-income individuals under age 65 with household income at or below 133% of the federal poverty level who are not otherwise Medicaid-eligible

Requires sliding scale subsidies for Medicaid-eligible individuals to purchase private health plans, with enhanced subsidies for those choosing high-deductible plans with health savings accounts, plus additional cost-sharing assistance based on income

Establishes incremental Medicaid reforms including a dual eligible integrated care demonstration project, a parental fee program for children receiving long-term services, housing payment assistance, and customized benefits packages for home and community-based services

Creates a 12-member Medicaid Reform Task Force with legislative and executive branch appointees to advise on program design, with a report due by December 1, 2026, and mandates studies on estate recovery and income/asset eligibility limits