Dallas‑area hospitals learned this week that the Trump administration is holding up roughly $10 billion in Medicaid payments to Texas providers. The pause is costing hospitals about $27 million each day, threatening services such as NICUs and maternity wards.
Paxton’s silence contrasts with past legal wins
Three years ago, Attorney General Ken Paxton sued the Biden administration over a similar Medicaid funding threat to the Comprehensive Hospital Increase Reimbursement Program (CHIRP). That lawsuit forced a federal judge to rule that Texas’ informal hospital agreements were permissible, preserving billions in federal aid.
Now, with the Trump administration seeking to change Texas’ hospital tax structure, Paxton has not filed a lawsuit. Governor Greg Abbott, a staunch Trump ally, publicly affirmed that Texas will not back down, marking a rare Republican‑to‑Republican clash in Washington.
Political calculus may be at play
Political science professor Brandon Rottinghaus of the University of Houston notes that Paxton is in a tight Senate primary against a well‑funded Democratic challenger. Defying President Trump and his loyal base could be a liability, so Paxton appears to be biding his time.
“He’s in a very politically delicate situation, and he doesn’t want the story to be, Trump versus Paxton,” Rottinghaus said.
Impact on Texas families
Medicaid covers four million Texans, including about one‑third of the state’s children and two‑thirds of nursing‑home residents. Hospital leaders warn that continued cuts could force closures of critical units and delay capital improvements.
Parkland Health CEO Dr. Frederick Cerise estimated the daily loss at $528,000 for his system alone. He expressed uncertainty about the state stepping in to fill the gap.
What’s next?
Early voting for the 2026 midterm primaries begins Oct. 19, and the Republican National Convention convenes in Dallas next week. The Medicaid dispute may become a flashpoint in the upcoming elections, especially if Texas hospitals are forced to curtail services.
For now, the Trump administration’s rule change remains in effect, and Texas officials continue to argue that the existing tax‑collection model is lawful and essential for maintaining critical health care for the state’s most vulnerable citizens.
Original reporting: Texas Tribune (HLL/CB) — read the source article.
