HB 197 proposes expanding Medicaid eligibility in Texas under the federal Patient Protection and Affordable Care Act (ACA). Specifically, it requires the Texas Health and Human Services Commission (HHSC) to provide Medicaid coverage for all individuals eligible under ACA’s federal guidelines, contingent on federal matching funds. HB 197 includes a provision for an annual report to state leadership, outlining the impact of this expanded eligibility on uninsured rates, state and local healthcare costs, and uncompensated hospital care. The bill's implementation depends on the approval of a constitutional amendment by Texas voters in the 2025 general election.