What happens to Medicaid?

Medicaid keeps running, because Texas already runs it. Texas administers the entire program today, funds a large share of it from its own treasury, and would simply stop sending the rest of the money to Washington first. Nobody on Medicaid loses their coverage at independence.

Texas already operates Medicaid, start to finish

Medicaid is not a Washington program that happens to Texans. It is a Texas program that Washington helps fund and heavily regulates. The Texas Health and Human Services Commission determines eligibility, enrolls families, pays providers, manages the health plans, and runs the entire operation. Medicaid is roughly a $51 billion program in Texas, and the state already funds about $20 billion of that from its own budget. The agency, the workforce, the rules engine, and a large slice of the money are already Texan. Independence does not build a new program. It hands Texas full control of one it already operates.

Medicaid is welfare Texas keeps funding, and we are honest about that

We do not pretend Medicaid is free or that it disappears. It is means-tested assistance, not an earned benefit like Social Security, and the 2026 analysis counts every dollar of it as a real cost an independent Texas carries the whole way through. Texas keeps funding Medicaid because Texas takes care of its own. The difference is that the money stays home and the rules get written in Austin instead of arriving from Washington with conditions attached.

The current deal already short-changes Texas

The arrangement Texans are told to fear is the one they already live under, and it is not a good one. On Medicaid, Washington writes the rules and pays only part of the bill, and the federal share comes with strings and matching requirements that force Texas to put up its own funds to unlock it. Much of what gets counted as "Washington's spending in Texas" was paid for, in part, by Texans a second time. Independence does not add that burden. It ends the part where Texas pays for rules it had no say in writing.

Continuity is the design, not an afterthought

Following a vote, the relationship between Texas and the United States is settled through negotiation and a transition period in which existing arrangements continue while the details are worked out. Medicaid does not switch off during that window. The same families stay enrolled, the same clinics keep billing, and the same state agency keeps paying, because the program never left Texas in the first place. A government built on getting closer to the people it serves does not begin by dropping coverage for its poorest children, seniors in nursing homes, and Texans with disabilities.

A program answerable to Texas, not to fifty-state mandates

The real upgrade is accountability. Today, the most expensive Medicaid rules are decided in Washington and applied to Texas whether Texas agrees or not. An independent Texas sets its own Medicaid policy, answerable to Texas voters, funded by Texans, without asking permission to adjust eligibility, benefits, or delivery to fit Texas. Self-government does not threaten the safety net. It puts the people who depend on it in charge of the people who run it.

The bottom line

Medicaid is administered by Texas, funded in large part by Texas, and kept by Texas. Independence ends the round trip to Washington, keeps every Texan covered through the transition, and lets Austin set the terms instead of paying for rules written somewhere else.