Texas performs well on Medicaid expansion status, redetermination performance, MCO presence, private coverage retention, Medicaid spending growth, per-enrollee cost growth, improper payment performance, MFCU enforcement activity, existing APCD infrastructure, CON law status, and IMLC participation. At the same time, Texas’s overall score is constrained by no early work requirement activity, high Medicaid budget exposure, low primary care provider supply, and limited provider flexibility.