HB26

HB26 lets Texas Medicaid managed-care contracts permit nutrition counseling and instruction as an alternative to other covered state-plan services. It also authorizes—but does not require—the state to establish a separate nutrition-support pilot for certain pregnant Medicaid recipients. It does not create a general entitlement to free groceries or home-delivered meals for everyone on Medicaid. Final law; official history.

The regular contract pathway is limited. The alternative services must be medically appropriate, cost-effective and evidence-based, approved by the state Medicaid managed-care advisory committee, and included in the contract. Contracts must permit the option; the law does not require every managed-care organization to offer every service. Recipients cannot be required to take a listed substitute instead of the state-plan service. For the ordinary nutrition list, only counseling and instruction may be included: home-delivered meals, food prescriptions and grocery support are excluded. Existing mental-health/substance-use alternatives remain in the provision, while the state-plan services that can be replaced are no longer described solely as mental-health/substance-use services. Section 1.

The Health and Human Services Commission must report annually how often listed alternatives are used and consider their actual cost and use when setting a managed-care organization’s capitation rates—the payments the state makes to the plan under its contract. These reporting and rate-setting duties existed before HB26; the revised service framework now falls within them. Section 1.

A separate, optional pregnancy pilot can go further. The commission may establish a pilot for Medicaid recipients who are pregnant and have a diagnosed chronic condition or disease that could contribute to a high-risk pregnancy or birth complications. The statute gives gestational diabetes, hypertension and obesity as examples, not an exhaustive list. Under that pilot, plans may offer counseling and instruction, medically tailored meals together with counseling/instruction, and other evidence-based nutrition support chosen by the commission to improve maternal and infant health. A medically tailored meal must be designed by a registered dietitian as part of a treatment plan. The pilot is an express exception to the ordinary counseling-only limitation. Section 2.

If the pilot is established, the commission must collect and analyze participation/compliance, pregnancy outcomes, changes in chronic-condition symptoms, and newborn/infant outcomes. After the pilot ends, it must report outcomes and recommendations to the legislature as soon as practicable. The pilot ends August 31, 2030; its authorizing section expires September 1, 2031, leaving time for follow-up reporting. Authorization is not proof that the pilot has launched or that a particular plan offers meals. Section 2.

Timing and federal approval matter. The contract changes apply to contracts entered into or renewed on or after September 1, 2025. Earlier contracts remain governed by the prior law until the applicable transition. If a state agency determines federal permission is necessary for a provision, it must request that permission and may delay that provision until approval is granted. This is not an automatic September 1 start date for every nutrition service. Sections 3–5.