Texas Senator Jane Nelson (R-Flower Mound), head of the Health and Human Services Committee has come out and said that Texas may not say no to federal Medicaid expansion funds as part of the Affordable Care Act after all.

This seems like quite the change of heart, especially after Lieutant Governor’s confirmation that Medicaid expansion would be “off the table” this legislative session and Governor Perry’s claim back in July in a letter to Health and Human Services Secretary, Kathleen Sebelius, that he would “not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government."

So, what’s the catch?

They want to do Medicaid the “Texas way.” But not quite the block grant they imagined, one that would allow Texas to receive the money and redesign the Medicaid program as they wish (this has been pushed for by many Republicans, including Governor Perry). Instead, Senator Nelson has said they are now looking to receive a waiver from the federal government. This would allow Texas to tailor the program while still working within some federal guidelines.

One part that Nelson and others envision would require some Medicaid recipients to pay for at least part of their health care, either through income-based premiums or co-payments. This is something that the federal Medicaid program has rejected.

This may prove to be enough for Nelson and others. But is it enough for those Texans whose healthcare fates rest in their hands?