PTuG2 - Lessons from the Unexpanded: What Expansion States Can Learn from Texas FQHCs as Medicaid Shrinks

Session Description: With Medicaid redeterminations underway and the passage of the “One Big Beautiful Bill,” many expansion states are beginning to experience the same pressures long faced by Federally Qualified Health Centers in Texas — one of the nation’s largest uninsured states and a non-expansion state since the ACA’s inception.

This panel brings together health center executives from Texas to explore what it means to deliver care, maintain financial stability, and advocate for policy change in a chronically underfunded coverage environment. Panelists will share operational strategies for sustaining access to care when coverage contracts, including how to build robust partnerships with local entities, optimize revenue through PPS and alternative grants, and design care models that serve high-uninsured populations effectively. They’ll also discuss the real risks expansion states face if they fail to prepare for coverage volatility and what proactive planning can look like.

Attendees will leave with a grounded understanding of:

How Texas health centers have adapted their models to survive without Medicaid expansion;

What coverage contraction looks like in practice;

Practical tactics to build operational and policy resilience now.