Recap of Key Health Coverage Issues from the 2025 Texas Legislative Session
Every person in Texas deserves access to affordable, high-quality healthcare that allows us to get preventive care and treatments, avoid medical debt, and live healthy lives. Our families and communities deserve stability in our public health systems, our economies, and our workforces that correlates with high coverage rates and high healthcare utilization rates.
Members of the Cover Texas Now (CTN) coalition, partner organizations, and lawmakers who care about Texans’ healthcare access had to overcome many community health-threatening proposals over the past 140 days. Our work in the 89th Legislative Session builds on our past work and will support our goal of comprehensive coverage for all Texans leading into the 90th Legislative session and for years to come.
We envision a state where all Texans have good, affordable health insurance and know how to use their coverage. With threats to health coverage programs from the federal government looming, CTN’s work to stabilize healthcare financing and delivery systems and to increase coverage and utilization rates across the state is more important than ever.
Legislative Policy Priorities from the Recent Texas Legislative Session:
Close the Health Insurance Coverage Gap:
We thank Sen. Nathan Johnson for authoring SB 232 and continuing to engage in the conversation about how Texas lawmakers can best support rural and urban hospitals, doctors, and patients across the state by providing health insurance to nearly one quarter of uninsured Texans. That Medicaid expansion bill didn’t get a committee hearing this year and had fewer coauthors than in past years. Rep. John Bucy’s Medicaid expansion amendment, designed to close the health insurance coverage gap, spurred an inspiring debate on Budget Day. Unfortunately, lawmakers voted it down. CTN looks forward to the ongoing work with Texas lawmakers to bolster our healthcare delivery systems; save money for the state, local governments, families, and individuals; and improve health outcomes for all Texans.
CTN members and partners were able to support lawmakers in preventing HB 139 from passing. The bill would have allowed employers in Texas to offer junk health insurance plans to employees. HB 139’s “employer choice of benefits plans” would not have met state standards—or, in many cases, federal standards—for qualified, comprehensive health insurance. Many employees who may have enrolled in these plans would not have known that they were purchasing junk insurance because the plans would have come from their employers. Had this policy passed, it would have increased the statewide uninsured rate by allowing employers to offer to employees limited benefits plans that would have left employed Texans uninsured by qualified health insurance plans.
Reduce Costly Red Tape Barriers to Benefits:
The most recent data from the federal Centers for Medicare and Medicaid Services shows that nearly one in five Medicaid applications processed in the state takes longer than the federally-mandated 45-day standard application processing deadline. Those data also show that by completing just 9% of Medicaid applications using verified electronic data sources like the USPS and the IRS (a process called ex parte data verification), Texas has the lowest ex parte renewal rate in the US. These numbers reflect the burdensome and time-consuming processes both applicants and HHSC eligibility workers must undergo for HHSC to enroll eligible people in Medicaid, the Children’s Health Insurance Program (CHIP), Healthy Texas Women, and Medicare Savings Programs (MSPs). Individuals, families, children, disabled people, seniors, and pregnant people get lost in these procedural cracks and go without health insurance for too long—or, in some tragic cases, forever.
Faced with the prospect that Medicaid enrollees would face increased burdens of proof for confirming Medicaid and CHIP application data that HHSC could access through verified through ex parte processes, CTN members helped stop the passage of SB 921, which would have limited admissible ex parte processing. We also helped stop SB 961, which would have increased intermittent income checks and limited self-attestation of hard-to-prove household data like roommate status and would have prevented Texas HHSC from opting into federal waivers of income checks made possible to areas suffering from public health crises or natural disasters.
Texans Care for Children, the Children’s Health Coverage Coalition, and CTN members supported Rep. Ann Johnson’s HB 3940, which will require the HHSC to remind Medicaid Managed Care Organizations, hospital staff, and people on pregnancy Medicaid every year and new parents and caregivers that newborns born to people enrolled in Medicaid at childbirth are automatically eligible for Medicaid and that the hospital or birthing center can bill Medicaid under the birthing parent’s Medicaid ID number until the child is enrolled in Medicaid and assigned a separate Medicaid identification number. This process will help families avoid getting inaccurate medical bills for labor and delivery while they’re also dealing with newborn children. The bill is currently on the governor’s desk for signing into law.
Around 400,000 children in Texas are likely eligible for Medicaid or CHIP but just not enrolled. Since income eligibility for the Supplemental Nutrition Assistance Program (SNAP), Texas’ food stamps program, is more restrictive than Texas’ Medicaid program for children, for families with children who are eligible for SNAP, their children are also eligible for Medicaid. HB 321 by Rep. John Bucy would have required HHSC to notify parents whose households are eligible for SNAP and that have children in the household that those children are likely eligible for Medicaid. The bill passed the Texas House but was never heard in a Senate committee. CTN partner Texans Care for Children educated many legislators and staff about the bill’s common sense approach to reducing uninsured rates among children from low-income families, and we look forward to supporting their efforts in the interim and in the 90th Texas legislative session.
Restore State-Funded Grants for Outreach and Local Enrollment Assistance:
We’re very grateful to Rep. Donna Howard for working with CTN member Every Texan to submit a proposed item to the 2026–2027 biennium budget that would have initiated funding to Texas’ 600+ HHSC-certified Community Partner Programs (CPPs), which support community members filling out the complicated applications for Medicaid, CHIP, SNAP, TANF, WIC, and (in some cases) Marketplace health insurance across the state. These incredible community health workers, navigators, and advocates also help Texans use our statewide healthcare offices to get healthcare by understanding their coverage, making appointments, organizing transportation, following up with doctors, and more. The item did not make it into the budget for the next biennium, so Every Texan will continue supporting those CPPs in our monthly Get Covered Texas and Seguro Texas coalition meetings and during our annual Texas State of Enrollment (TSOE) conference.
Establish a Legislative Directive for Agency-Led Language Access Plan:
As part of the Texas Language Justice Collective (TLJC), CTN members helped advance the collective’s HHSC-focused language access bill further than any bill from the collective has gotten in the Texas legislature. HB 4838, authored by Rep. Morales Shaw, would have required TX HHSC to hire a Language Access Coordinator to assess non-English speakers’ access to the HHSC programs like Medicaid, SNAP, and Medicare Savings programs and identify gaps in enrollment, education, and utilization. The coordinator would have reported back to HHSC with recommendations for increasing non-English speakers’ access to HHSC programs. CTN is honored to have worked with the TLJC on HB 4838 and will continue to support statewide and local efforts to increase language accessibility for benefits programs access, emergency preparedness notices, and more among non-English speaking communities.
Preserve Collection of and Access to Texas Health Data
Texans’ rights to data privacy will continue to inform CTN’s policy priorities, especially as the federal government attempts to access personally-identifiable information (PII) from federal and state databases, which are housed in the IRS, the Social Security Administration, TX HHSC, and private companies that help agencies administer programs. This session, CTN members helped stop HB 2587, which would have codified into state statute the Texas Governor’s Executive Order GA-46 from August 2024. The Executive Order, which requires hospitals to ask patients about their immigration status and report to TX HHSC on the costs of healthcare provided to undocumented community members, still stands. However, our work to stop HB 2587 from passing reflects our and our state and national partners’ commitments to restricting unnecessary collection of Texans’ data by state agencies and the sectors they oversee.
Key Takeaways and Next Steps:
Texas lawmakers across both aisles understand that communities around the state are facing increasing healthcare costs and limitations in service delivery; and if the federal government achieves its plans to cut healthcare access even more, CTN’s expertise, advocacy, network-building, and information-sharing will be crucial in the work to maintain and even improve community health outcomes in the state in wake of short-term and short-sighted policies that will make life harder, more expensive, and sicker for most Texans.
CTN’s healthcare-focused next steps include:
Working with state and national partners to defend Medicaid, CHIP, and Affordable Care Act/Marketplace health insurance from federal proposals to make the largest funding cuts to those programs in American history and leave millions without access to affordable healthcare.
Working with HHSC to improve the Texas Integrated Eligibility Redesign System (TIERS) as HHSC deploys the hundreds of millions of dollars the state budget allocates over the next two years to improving TIERS, through which HHSC processes Medicaid, CHIP, SNAP, and Healthy Texas Women applications. As one of the primary information technology systems at work in Medicaid and CHIP eligibility determinations in Texas, TIERS is such an important system to get right. An improved TIERS can process ex parte information accurately and quickly, determine eligibility accurately and quickly, and ensure efficient program delivery. These efficiencies will make applications easier and more accurate for people enrolling in HHSC programs. They will also reduce paperwork for HHSC staff members, who otherwise must review applications and supporting materials by hand, and for hospitals, clinics, and providers, who will get paid for their work faster. Due to these system improvements, whole communities will benefit from members with less stress due to long Medicaid and CHIP application wait times, inaccurate denials, confusing requests for verifying materials, and uncertain means of paying for medical expenses.
Monitoring HB 18 implementation to ensure grant funding for rural hospitals and clinics is going to serve the bill's intent to improve administration, training, and service delivery to more rural Texans.
Facilitating and supporting statewide coalitions and convenings to devise, coordinate, and implement strategies to stabilize healthcare financing and delivery systems and to increase coverage and utilization rates around Texas. Cover Texas Now members will continue to coordinate with Get Covered Texas (Medicaid/CHIP/ACA outreach, enrollment, and utilization), Seguro Texas (public charge, immigrants’ access to healthcare), Sick of It, Texas! (grassroots advocacy and healthcare leadership coalition), and the Texas State of Enrollment Conference (annual convening of statewide Medicaid, CHIP, ACA enrollment assisters for policy, program, and implementation updates), the Children’s Health Coverage Coalition, the Texas Women’s Healthcare Coalition, the Texas Language Justice Collective, Southerners for Medicaid Expansion, TX Immigration Orgs, Texas Grandparents Raising Grandchildren (kinship care coalition), the Protect Texas Medicaid coalition, and Texans for Healthcare Access.
Cover Texas Now members celebrate the hard work and successes of our members, community partners, and lawmakers during the 89th Texas Legislative Session in. We look to the interim and to our next session with immense gratitude to our members and partners; to Texas lawmakers who continue to prioritize the experiences of their middle-income and low-income constituents; and to Texas community members who live and work every day to support their families, friends, and neighbors. With support from Cover Texas Now, Texans will build better healthcare systems, more accessible food systems, and a more healthy future that works for everyone.