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Texas is classified as a restricted-practice state for NPs/APRNs, with ongoing physician-delegation and Prescriptive Authority Agreement requirements. Use this page as a verification map, not a substitute for legal advice.
6/9 roles restricted · Updated 2026-06-03
For education and operational planning only. Verify every citation with counsel, the relevant board, internal privileges, payer rules, and local policy before changing staffing, supervision, or clinical workflows.
California lets eligible NPs practice without standardized procedures after a transition (AB 890); Texas requires ongoing physician-delegation structures for NP/APRN and PA prescriptive authority. For a Texas FQHC, that can mean physician-delegator cost and credentialing dependency — a structural staffing constraint that differs from full-practice states and makes physician recruitment and delegation logistics more important.
Texas's 2025 effort to grant APRNs full (independent) practice authority did not advance. SB 911 (Sen. Cesar Blanco) was referred to Senate Business & Commerce on Feb 13, 2025 and did not receive a committee vote; the House companion HB 3794 had an April 14, 2025 hearing but did not become law. No APRN full-practice bill was enacted, so Texas remains a restricted-practice state. With a biennial legislature, the next opportunity is the 2027 session.
SB 911, 89th Texas Legislature (2025); House companion HB 3794Texas is a RESTRICTED-practice state (the inverse of CA's NP full-practice authority). Every APRN site needs a physician delegator + a maintained PAA with monthly QA meetings — a fixed physician-overhead cost and recruiting/credentialing constraint in Texas FQHC staffing models.
PAs are explicitly the physician's agent under delegated protocols — no independent practice. Same physician-delegator overhead and PAA credentialing as APRNs.
RNs are the supervising layer for LVNs/UAPs and anchor care-management / RN co-visit staffing models. 'Reduced' here flags only the absence of medical/prescriptive authority — nursing practice itself is not physician-supervised.
Every LVN needs a named supervisor on duty — a key staffing-ratio and supervision-coverage consideration for Texas FQHC clinic models.
No MA licensing board in Texas. MA duties (rooming, vitals, injections per order) must be covered by a physician's standing delegation orders with documented supervision.
The 180-hour DSHS training + mandatory certification for compensated CHWs is the key compliance gate for Texas FQHCs deploying outreach/Promotor(a) staff (contrast: California's CHW pathway runs through Medi-Cal + a different certification debate).
Behavioral-health therapists can deliver care independently at full licensure — a relative bright spot for Texas FQHC integrated-BH models — but medication management still needs a prescriber under physician delegation.
Texas FQHC dental programs operate under independent dentist authority; the dentist is the delegating/supervising authority for the dental team.
Because on-site dentist presence is not required for delegated acts (only an exam within 12 months), §262.002 enables FQHC mobile/school-based and 'alternate setting' dental programs under dentist supervision.
Texas DSHS and local partners will operate Operation Border Health at multiple South Texas sites July 21–23, providing no-cost general medical exams and location-specific preventive services while exercising disaster-response capacity. FQHC teams in border communities should treat the event as both a referral opportunity and a continuity risk: one-time care needs a documented handoff back to a longitudinal medical home for labs, chronic disease, prescriptions, and follow-up.
Texas Department of State Health Services →Legacy's current Acres Homes page posts July 14, 2026, welcomes new patients, and says appointments are available at 3011 W. Gulf Bank Road. It lists adult medicine, OB/GYN, pediatrics, and pharmacy, accepts Medicaid, CHIP, Medicare, Medicare Advantage, and most HMO/PPO plans, and offers help with sliding-fee options. The site credits a Houston Methodist donation for the expansion, confirming the clinic has moved from a construction announcement to patient access.
Legacy Community Health →Texas Medicaid & Healthcare Partnership announced that Custom Reports, the Medicaid Client Portal, Document Uploads, the Provider Message Dashboard, and My Account will move to TMHP IAMOnline on August 3. Because the change applies to all Texas Medicaid providers, FQHC revenue-cycle and eligibility teams should confirm each user's IAMOnline and multi-factor-authentication access before cutover, inventory service accounts and shared workflows that cannot migrate unchanged, and retain a downtime/escalation path for claims and enrollment work.
Texas Medicaid & Healthcare Partnership (TMHP) →New CMS data show Texas's effectuated ACA Marketplace enrollment fell from 3.42 million (2025) to 3.28 million (2026) — the state's first year-over-year decline since 2019 — after the enhanced premium tax credits expired December 31, 2025 and the average per-person premium rose from about $57 to $89 per month. Nearly 900,000 of the 4.17 million Texans who selected a 2026 plan never paid for coverage. Because Texas has not expanded Medicaid, the Marketplace is the primary coverage path for low-income adults above the poverty line, so a Marketplace contraction pushes more uninsured patients onto FQHC sliding-fee schedules and uncompensated-care rolls.
KSAT / The Texas Tribune (CMS data) →CommUnityCare Health Centers CEO Dr. Nicholas Yagoda confirmed at the July 1, 2026 Central Health Board of Managers meeting that a woman was detained by ICE agents on June 29 in the parking lot of the FQHC's north-central Austin health center, KXAN reported. 'I want to be clear, CommUnityCare does not participate in immigration enforcement,' Yagoda said, adding 'we have seen an uptick in people not showing up to appointments as well as cancellations.' More than 70% of CommUnityCare's patients identify as Latino and most live at or below 200% of the federal poverty line. Yagoda said the organization does not believe health centers are being targeted, though some sit in neighborhoods experiencing increased enforcement activity; board partners floated physical gates, an option Yagoda said in some ways contradicts who the organization is. Enforcement at care sites deters the exact patients FQHCs are chartered to serve, threatening continuity of care in a non-expansion state.
KXAN (NBC Austin) →TMHP's Release 4 moves the Long-term Care Online Portal, LTC Dashboard, Electronic Visit Verification Portal, and Care Forms to TMHP IAMOnline on August 24, 2026, following the separate Release 3 migration on August 3. TMHP scheduled activation emails for July 7 and August 18; each activation link is valid for seven days, and multifactor authentication is required. Users who already have an HHSC IAMOnline account for the State of Texas Electronic Provider System still must activate a TMHP IAMOnline account. Beginning August 24, users must change their password and access each assigned application at least once every 90 days or risk deactivation. The action applies to FQHC personnel who use these Release 4 applications or receive an activation email—not automatically to every employee or every Texas Medicaid-billing FQHC.
Texas Medicaid & Healthcare Partnership (TMHP) →Explore all 80 Texas community health centers in the directory.
Legal citations come from the Texas Occupations Code and state boards; confirm currency and local application before relying on them.