Every state is different. I'm honestly surprised she has Texas Medicaid. They didn't expand Medicaid so almost no one has it compared to other states that did. I'm wondering if maybe she doesn't have it.
But you can't accept Medicaid outside a particular state so I know that doctors, pharmacies, etc all just bill cash. In my state, you cannot charge a patient who has Colorado Medicaid so it's not just a matter of opting out, it's completely illegal.
@appalenia is a fabulous DPC lawyer though I don't remember which states she is licensed in...but I'd love your opinion on this one @appalenia