SB 638 amends the Texas Human Resources Code by adding Subchapter H, which mandates that the Texas Health and Human Services Commission (HHSC) expand Medicaid eligibility under the federal Patient Protection and Affordable Care Act (ACA). Under this expansion, HHSC will provide medical assistance to individuals who apply and are eligible for federal matching funds. Additionally, HHSC is required to submit an annual report on the expansion’s impact on uninsured rates, state and local healthcare costs, and charity care in hospitals. Implementation may be delayed if federal waivers are required. The Act is set to take effect on September 1, 2025​.