WASHINGTON, DC – Congressman Dan Crenshaw (R-TX02) highlighted the double standard the Centers for Medicaid Services (CMS) takes when it comes to states that do not participate in the Medicaid expansion program.

In a House Energy and Commerce Health Subcommittee hearing this week, Rep. Crenshaw questioned CMS Deputy Administrator Daniel Tsai about CMS’s latest interpretation of state financing requirements, which if implemented, would cost the State of Texas billions of dollars and hike health care costs for constituents across the district. Additionally, he asked why CMS is targeting Texas, along with Missouri and Florida (all Republican led States) with attempted audits when implementing the new interpretation of the Medicaid financing rules. CMS had not given Democrat-led states the same scrutiny, as detailed in both National Review and the Wall Street Journal Editorial Page.

Here is a link to the Congressman’s exchange with Deputy Administrator Tsai.

Rep. Crenshaw said the following in his remarks:

“There is generally a philosophical debate around how states should administer Medicaid. There is a line of thinking that Medicaid should be expanded to just enroll people, and states like mine where there is a more targeted approach. An approach that focuses on access. And focuses on making sure that the health infrastructure is funded so that the people who need care actually have a place to go, not just a piece of paper that says they have a place to go.”

“The problem that we have today is that CMS is actually targeting states as a result of that disagreement. As first reported by National Review, records show that CMS targeted red states like Florida, Texas, and Missouri based on a new interpretation of state financing rules, arrangements that had previously been approved [by CMS] numerous times. That new interpretation would cost states like Texas billions of dollars. This is an attempt to force them to go into Medicaid expansion.”


Many Texas elected officials, the Governor’s office, and Texas hospitals have raised concern about CMS’ legal authority to change state financing requirements in a statement of policy released last year, and the impact these policies would have on the safety net and access to care. Many Texas Congressional offices raised similar concerns through letters to CMS. 

CMS also recently issued an informational bulletin stating enforcement (and corrective actions) of newly implemented provisions related to financing will begin on January 1, 2028. The State of Texas continues to believe that CMS is applying an incorrect interpretation of current law and is overstepping their authority to regulate financing arrangements. The court case in Texas will continue to play out, and the injunction will prevent CMS from enforcing the new provisions.

As a reminder, CMS attempted similar financing rules in 2020, which were opposed by Texas Governor Abbott and Texas Lt. Governor Patrick. These rules would have cost the State of Texas billions of dollars and hiked local taxes on constituents.