Democrats file bills to expand Medicaid during Texas’s special session

Texas’s special session kicked off Thursday, and Republicans — led by Gov. Greg Abbott — are planning to push through several of Abbott’s stalled priority bills including legislation on voting regulations, abortion restrictions, and critical race theory. However, Democrats are using the opportunity to continue their calls for Texas to expand Medicaid under the Affordable Care Act (ACA).


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Abbott’s list of priorities for the session didn’t include anything about Medicaid and legislation to expand the program is unlikely to gain traction in the Republican-controlled legislature. Unlike Abbott’s priority bills, none of the Medicaid-related bills have been scheduled for hearings. 

Three Democrats have introduced bills that would require the state to expand Medicaid under the ACA — Reps. Bernal, Celia Israel, and John Bucy. All three bills would also require the Health and Human Services Commission (HHSC) to produce an annual report on the observed impacts of expansion.

Bernal is sponsoring a separate bill that has the same provisions of his expansion bill but includes a section extending eligibility to more children. HB 108 would create a buy-in program allowing families with incomes less than 200% of the federal poverty level (FPL) to purchase health insurance coverage for their children (if they are under 19) from Medicaid managed care plans. It would create a sliding-scale premium rate for families with incomes between 133% and 200% of the FPL.

A related effort from Bernal would allow counties to expand Medicaid on their own. Interested counties could ask HHSC to request a Medicaid 1115 waiver from the Centers for Medicare and Medicaid Services that would allow them to expand the program.

In a different approach, some legislators are proposing a constitutional amendment that would mandate Medicaid expansion. Bucy’s HJR 5, Reynolds’ HJR 10  and Israel’s HJR 7 are identical bills that add Section 74 to the Texas Constitution, codifying the expansion requirement.

Reynolds has also filed HB 69, which, instead of expanding Medicaid, aims to reform the state’s current Medicaid program “the Texas Way” to provide low-income individuals with health insurance coverage through the private market.

This bill would reform Texas’s Medicaid program to provide acute care benefits to individuals under 19 who are at or below the FPL and either receiving social security income or in a residential or foster care setting. It would establish premium, cost-sharing, coinsurance, and deductible subsidies for these individuals, which would be determined based on current market premiums and the individual’s ability to pay.

The bill would also create a program to connect individuals who aren’t eligible for Medicaid coverage with coverage through the private market. After requesting federal approval for matching funds, the state would use these funds as well as premium tax revenues to create a cost-neutral program in which low-income individuals could receive financial support for purchasing coverage. Eligible individuals must be under 65 and have a household income at or below 133% of the FPL.