HB 2604 proposes to expand Medicaid eligibility in Texas under the Patient Protection and Affordable Care Act (ACA). The bill mandates that the Texas Health and Human Services Commission (HHSC) provide medical assistance to all individuals eligible for federal matching funds under the ACA. It requires the executive commissioner of HHSC to adopt rules necessary for implementation. Additionally, the bill mandates an annual report to state leadership detailing the effects of Medicaid expansion on uninsured rates, state and local healthcare costs, and uncompensated hospital care. The expansion would apply to eligibility determinations made on or after January 1, 2026. However, the bill's enactment is contingent upon the approval of a constitutional amendment by Texas voters requiring Medicaid expansion.