What the 2026 Federal Medicaid Cuts Mean for Texas Communities

In late June 2026, Congress passed federal legislation that includes the most significant reductions to Medicaid funding in a generation. For millions of Americans who depend on Medicaid for their healthcare — including approximately 4.8 million Texans — the changes are not abstract policy. They are a direct threat to access to care.

DaisyMe Foundation is committed to making sure our community understands what is changing, who is most affected, and what options exist.

The legislation makes several structural changes to Medicaid that will take effect over the next 18 to 36 months:

Work requirements. Adults ages 19–55 without dependents will be required to document 80 hours per month of work, job training, or community service to maintain Medicaid eligibility. Research on previous state-level work requirement experiments — including Arkansas's 2018 program — consistently found that they primarily caused eligible people to lose coverage due to paperwork burdens, not because they were actually ineligible.

Reduced federal matching rates. The federal government will reduce its share of Medicaid costs, shifting more of the burden to states. Texas, which already has one of the most restrictive Medicaid programs in the country, will face pressure to further limit eligibility or benefits.

Elimination of enhanced FMAP for expansion states. States that expanded Medicaid under the ACA will see reduced federal matching funds, potentially making expansion financially unsustainable for some states.

Stricter eligibility redetermination requirements. States will be required to conduct eligibility redeterminations more frequently, increasing the administrative burden on enrollees and the likelihood of coverage loss due to paperwork issues rather than actual ineligibility.

Texas has the highest uninsured rate in the nation — approximately 18% of the population — in large part because Texas did not expand Medicaid under the ACA. The Medicaid program that does exist in Texas covers primarily children, pregnant women, and people with disabilities.

Black Texans are enrolled in Medicaid at higher rates than the state average, reflecting higher rates of poverty driven by structural economic inequality. Approximately 28% of Black Texans are enrolled in Medicaid or CHIP.

Children are the largest group of Medicaid enrollees in Texas. Approximately 3.1 million Texas children receive healthcare through Medicaid or CHIP. Cuts that reduce state funding will put pressure on the benefits and provider networks available to these children.

Pregnant women enrolled in Medicaid face particular risk. Texas Medicaid currently covers prenatal care and delivery for income-eligible pregnant women. Any reduction in coverage or benefits directly affects maternal and infant health outcomes — in a state that already has one of the highest Black maternal mortality rates in the country.

Community health centers that serve uninsured and Medicaid patients will face reduced reimbursement, threatening the financial viability of the safety net providers that low-income communities depend on most.

If you or someone in your family is currently enrolled in Medicaid, here is what you should do now:

Make sure your contact information is current. Eligibility redeterminations will be sent by mail. If the state cannot reach you, you may lose coverage even if you are still eligible. Update your address and phone number with the Texas Health and Human Services Commission at hhs.texas.gov.

Understand the work requirement documentation process. If work requirements take effect, you will need to document your hours. Start keeping records now — pay stubs, training certificates, volunteer logs.

Know your other options. If you lose Medicaid coverage, you may be eligible for subsidized coverage through the ACA marketplace. DaisyMe Foundation's health navigators can help you understand your options and complete enrollment.

Connect with advocacy organizations. The Texas Health Institute, Every Texan, and the Children's Defense Fund Texas are tracking these changes and advocating for community members. Your voice matters.

We are expanding our health navigation capacity specifically to help community members navigate coverage transitions. Our navigators can help you:

• Understand whether you are affected by the changes
• Complete Medicaid redetermination paperwork
• Explore alternative coverage options
• Connect with community health centers that provide sliding-scale care regardless of insurance status

Connect with a health navigator or learn more about our programs.

Healthcare coverage is not a luxury. It is the difference between catching a chronic disease early and managing it for life, between a safe pregnancy and a preventable death, between a child who thrives and one who falls behind because untreated illness kept them out of school.

The communities that will bear the greatest burden of these cuts are the same communities that have always borne the greatest burden of healthcare inequity. DaisyMe Foundation will continue to stand with those communities — providing information, navigation, and advocacy — for as long as it takes.

DaisyMe Foundation is a 501(c)(3) nonprofit advancing health equity through education, advocacy, and community navigation. This article is for informational purposes and does not constitute medical advice. Policy details are based on information available as of June 28, 2026.