TX SB45

Requires Texas to expand Medicaid eligibility to all individuals who qualify for federal matching funds under the Affordable Care Act (ACA), which generally covers adults with incomes up to 138% of the federal poverty level

Mandates the Health and Human Services Commission submit annual reports by December 1 to state leadership on the expansion's effects, including impacts on uninsured rates, state and local health care costs, and hospital charity/uncompensated care costs

Applies to eligibility determinations made on or after January 1, 2026, regardless of when the individual submitted their application

Requires the executive commissioner to adopt rules for implementation and notify federal agencies of the expanded eligibility, with authority to seek necessary federal waivers

Takes effect January 1, 2026, only if voters approve a related constitutional amendment proposed by the 89th Legislature requiring Medicaid expansion