The Association for Community Affiliated Plans (ACAP) is a national trade association which represents not-for-profit Safety Net Health Plans. Collectively, ACAP plans serve more than twenty million enrollees, representing nearly half of all individuals enrolled in Medicaid managed care plans.

Our mission is to strengthen not-for-profit Safety Net Health Plans in their work to improve the health of lower-income and vulnerable populations. Our vision is to improve the health and well-being of lower-income and vulnerable populations and the communities in which they live.

Through the Medicaid is US campaign, ACAP has strengthened its advocacy as a voice for Medicaid.


ACAP has joined the Alliance of Community Health Plans (ACHP) to file a joint amicus curiae brief in support of the Affordable Care Act in the case of Texas vs. United States. The case is currently pending with the United States Court of Appeals for the Fifth Circuit, after a federal district judge in Texas ruled that the Affordable Care Act was unconstitutional. 

Click Here to Read the Full Amicus Curiae Brief

The Affordable Care Act has had a transformative effect on millions of people covered by ACHP and ACAP members, enabling them to access health care, manage pre-existing and chronic conditions, and lead better, more engaged lives. The ACA’s expanded access to affordable healthcare with meaningful benefits furthered the core mission of not-for-profit community health plans to transform healthcare in their communities by reducing costs, improving health outcomes, and delivering high quality care. Absent the ACA, millions will lose health insurance coverage and access to health care, crippling ACHP and ACAP member plans’ abilities to fulfill their commitments to their communities. 


Upholding the district court ruling would imperil coverage for millions of people by cutting off Marketplaces and cutting off funding for the Medicaid expansion. It would also have repercussions that the Administration has not likely contemplated, ranging from reopening the ‘donut hole’ in Part D plans to eliminating authority for Section 1332 waivers. 

As a matter of legal reasoning, it is curious that Congressional intent is a significant issue in this case. The 115th Congress could have chosen to repeal the entire ACA. They instead chose to zero out the penalty for the individual mandate while leaving the rest of the statute intact. Is there a clearer signal of intent than actions themselves? 

If the Fifth Circuit sustains the trial court’s ruling, it will have disastrous effects on millions of people’s ability to access and afford health care and may cripple the ability of ACHP and ACAP member plans to serve their communities’ needs for high-quality health care. 


One great irony in this case is that the State of Texas is ignoring the impact this litigation would have on its own citizens in the Lone Star State. 

Community Health Choice is an ACAP member in Harris County, Texas. It was created by the Harris County Hospital District as a separate not-for-profit organization specifically to serve low-income, underserved residents of the Houston area by becoming licensed as a health maintenance organization and contracting with the State of Texas for its Medicaid Managed Care program. It has been serving low-income residents who qualify for Medicaid since 1997, and entered the federally-facilitated health insurance marketplace in 2014. Community offered seven plans in the Texas ACA marketplace in 2018.  

Community serves approximately 275,000 Medicaid or CHIP insurance recipients and roughly 110,000 people under its marketplace plans. Community estimates that more than 80,000 of its marketplace enrollees rely on the ACA’s advance premium tax credit and/or cost-sharing reductions to afford coverage. Because Community serves a low-income population, many of its members previously were uninsured, have pre-existing conditions, cannot afford large deductibles, and lacked access to health insurance and, by extension, much-needed medical care.  

The Texas vs. United States lawsuit puts this much-needed medical care at risk. 


As a voice for Medicaid, ACAP has continued to advocate for all Americans who are made healthier through the Affordable Care Act.  

Our advocacy was instrumental in protecting the ACA from hostile action in Congress. Now we are fighting to protect the ACA from hostile action in federal court. 

As a fellow advocate for Medicaid, please lend your voice to this effort. Please share our amicus brief so that others can learn about the threat this lawsuit poses to our healthcare system.