Hinojosa targets Medicaid expansion despite legal and budget hurdles
The incoming governor faces a complex path to covering 1 million uninsured Texans, complicated by federal work requirements and state legislative controls.
By Pedro Barnes ·
More than 5 million Texans currently lack health insurance, a figure that has risen since 2015. With 16% of the state’s population uninsured, Texas leads the nation in the share of residents without coverage. The incoming administration aims to close this gap by expanding Medicaid to low-wage, working-age adults who currently do not qualify.
State Rep. Donna Howard, D-Austin, noted that expansion would bring up to $10 billion annually in federal funds to the state. Under the current system, Texas must pay a 10% share of expansion costs to access 90% federal funding. However, new federal rules from the One Big Beautiful Bill Act of 2025 impose work-reporting requirements that could increase administrative burdens. For some states, the staff needed to monitor these restrictions has added up to $15 million in costs.
Gov.-elect Gina Hinojosa has identified Medicaid expansion as a top priority. In a post-election interview with KPRC in Houston, she stated, “What my healthcare position is to ensure every Texas child has quality healthcare.. It is a sin.” She argued that expanding the program is the method to achieve this goal. Lt. Gov.-elect Vikki Goodwin shares this priority. Despite a Democratic sweep of statewide offices last week, the Texas Senate remains controlled by Republicans, creating a legislative hurdle for passing a traditional expansion bill.
A specific legal constraint complicates the executive approach. Texas law prevents the state from altering Medicaid eligibility requirements without legislative approval. It is unclear whether Hinojosa can bypass the legislature by directing the Texas Health and Human Services Commission to submit a plan to the Centers for Medicare and Medicaid Services. This uncertainty contrasts with states like Kentucky and West Virginia, where governors used executive orders to expand coverage.
Policy groups are discussing a “trigger” bill as an alternative. This legislation would activate Medicaid expansion only if the incoming Democratic Congress repeals specific federal restrictions. Charles Miller, director of Health & Economic Mobility Policy at Texas 2036, said this approach would remove the concept of the coverage gap. He noted that as people gain coverage, they tend to seek more care and gain protection against medical debt.
The expansion would cover adult citizens in families of four earning between $4,000 and $44,000 per year, according to Cover Texas Now. Currently, no childless working-age adult in Texas can qualify for Medicaid. Lynn Cowles, policy director for Every Texan, emphasized that this change would allow hospitals and local governments to stop spending hundreds of millions of dollars annually on uncompensated care for uninsured residents.
Dr. Edwin Park, a research professor at Georgetown University, explained that improved operating margins for hospitals would result from fewer uninsured patients. This financial stability allows hospitals to keep doors open and avoid cutting staff. However, the new working-age recipients will face a requirement to work at least 80 hours per month to maintain their coverage under federal rules.
The incoming administration must also address budget constraints. Agencies were asked to slash budgets by 3% under Gov. Greg Abbott. Howard said lawmakers are looking to increase access through mobile health clinics and faster provider payments in the interim. She stated, “We can’t pass something that is going to not achieve our goals,” indicating a preference for waiting until federal restrictions are adjusted.
