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Key Texas rules on Medicaid, naloxone, overdose Good Samaritan protection and the 988 crisis line. Each item links to its official source and shows the date it describes. Only items checked against an official source are shown.
Not legal advice. This page summarizes public policy information for general education. It is not legal or medical advice, and laws change. Check the linked official source, or ask a lawyer or health professional, before relying on it.
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Medicaid
Medicaid Expansion
Texas has not adopted the ACA Medicaid expansion.
Medicaid Work Requirements
The federal budget reconciliation law signed on July 4, 2025 (Public Law 119-21, section 71119) requires states that expanded Medicaid to make coverage for expansion adults conditional on work requirements beginning January 1, 2027. States may start sooner through waivers or state plan amendments, and CMS may grant good-faith exemptions that end no later than December 31, 2028.
Medicaid Coverage of Opioid Use Disorder Medications
Federal law requires every state Medicaid program to cover all FDA-approved medications for opioid use disorder, with related counseling and behavioral therapy. The requirement began on October 1, 2020 under section 1006(b) of the SUPPORT Act and was made permanent by the Consolidated Appropriations Act, 2024.
State Medicaid Substance Use Treatment Highlights
Texas Medicaid must cover all three FDA-approved medications for opioid use disorder (methadone in opioid treatment programs, buprenorphine and naltrexone), and the state does not have a CMS-approved section 1115 substance use disorder demonstration. A 2023 KFF survey found at least one standard buprenorphine product available without prior authorization in fee-for-service Medicaid.
Naloxone (Narcan)
Over-the-Counter Naloxone
Narcan (naloxone hydrochloride 4 mg nasal spray) was approved by the FDA for sale without a prescription on March 29, 2023. This federal approval applies in every state.
State Naloxone Access Law
Texas has a naloxone access law. These laws vary by state but generally make it easier to prescribe, dispense and carry naloxone, and protect people who give it in an emergency. PDAPS reports every state and DC had one by July 1, 2017.
Getting Naloxone from a Pharmacist Without a Prescription
Texas law lets prescribers issue naloxone standing orders, but the state has not issued one blanket order for pharmacies; pharmacies rely on standing orders from individual prescribers, such as the Texas Pharmacy Association's program (launched 2016) or chain pharmacies' own orders. Narcan nasal spray is also sold over the counter nationwide.
Good Samaritan Overdose Law
Good Samaritan Overdose Protection
Texas has a drug overdose Good Samaritan law that gives some legal protection to people who call for help during an overdose. The scope (protection from arrest, charge or prosecution, or only a defense in court) varies by state; read the statute for details.
988 Crisis Line
988 Suicide & Crisis Lifeline
Since July 16, 2022, calling or texting 988 anywhere in the United States connects to the 988 Suicide & Crisis Lifeline.
State 988 Funding
Texas has no 988 phone fee. HB 5342 (2025) created a 988 Suicide and Crisis Lifeline trust fund held outside the state treasury, funded by gifts, grants and donations, and ordered a study of a possible fee. It took effect September 1, 2025.
Sources
- KFF: Status of State Medicaid Expansion Decisions
- CMS / Medicaid.gov: SHO #20-005: Mandatory Medicaid State Plan Coverage of Medication-Assisted Treatment
- CMS / Medicaid.gov: Substance Use Disorder Section 1115 Demonstration Opportunity (approved states)
- U.S. Food and Drug Administration: FDA Approves First Over-the-Counter Naloxone Nasal Spray
- PDAPS, Center for Public Health Law Research at Temple University: Naloxone Overdose Prevention Laws
- https://statutes.capitol.texas.gov/GetStatute.aspx?Code=HS&Value=483.102
- PDAPS, Center for Public Health Law Research at Temple University: Good Samaritan Overdose Prevention Laws
- Federal Communications Commission: 988 Suicide & Crisis Lifeline
- State of Texas: Tex. Gov't Code § 547.0551; HB 5342 (89th Legislature, 2025)