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Chapter 2: Medicaid History and Organization

Texas Medicaid operates within a framework established by federal law, but the State of Texas

manages key elements of the program. Over time, both federal and state changes have affected

Medicaid in Texas. This chapter outlines the history and organization of the Medicaid program

in Texas.

History and Background

Congress established the Medicaid program under Title XIX of the Social Security Act of

1965 to pay medical bills for low-income persons who have no other way to pay for care. Texas

began participating in the Medicaid program in September 1967.

During the late 1980s and early 1990s, Congress expanded Medicaid eligibility to include

a greater number of people with disabilities, children, pregnant women, and older persons. These

changes helped fuel the growth of the Medicaid program, and the Texas Medicaid population

tripled in just a decade, adding more than one million people between 1990 and 1995 alone.

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