County-Level Projections of Medicaid Expansion's Impact in Texas

Abstract

Texas is one of twelve states nationwide that has not expanded Medicaid, despite the largest number of uninsured residents in the country. One commonly cited reason is the budgetary implications of a large increase in entitlement spending. In this brief, we summarize the research on fiscal impacts of Medicaid expansion and provide estimates of the number of currently uninsured Texans who would be eligible for Medicaid expansion, by county, as well as how much new federal annual Medicaid spending would be expected if those Texans enrolled in Medicaid. We estimate that 954,000 newly eligible adults would enroll in an expansion, bringing approximately $5.41 billion in federal dollars annually to the state. With a required state matching share of 1 for every 9 federal dollars, and numerous potential offsets for the state portion, the fiscal implications appear to be favorable from the state and local government perspective. In the context of uncertainty around future direct funding for hospitals and the pandemic that continues to damage local economies and health systems, Medicaid expansion may be able to provide some fiscal relief.