Texas hospitals will begin collecting information regarding the immigration status of patients who are not legally in the United States this week. Governor Greg Abbott's requirement aims to assess the healthcare costs tied to undocumented immigrants in the state to then request federal reimbursements.
Abbott signed the order in August, claiming that Texas "absorbs a large percentage of the costs associated with medical care for individuals who are not lawfully in the United States." Despite the policy, hospitals are required to assure patients that their citizenship status would not affect their access to care. However, experts warn of potential blowback.
With the highest uninsured rate in the nation at 17%, Texas has approximately five million residents without health insurance, the Texas Hospital Association (THA) reported. Last year, hospitals provided over $8 billion in care for the uninsured, with more than $3 billion remaining unreimbursed. However, most uninsured Texans are citizens, as reported by the Texas Tribune.
While Texas is home to about 1.6 million undocumented immigrants, they utilize hospital services less frequently than citizens and represent only a portion of the overall costs borne by the state's healthcare system.
Concerns have emerged from organizations like the American Civil Liberties Union (ACLU) of Texas, with fears that the new requirement may discourage undocumented residents from seeking necessary medical attention.
David Donatti, a senior staff attorney with the ACLU of Texas, said patients are not obligated to respond to the question and cannot be denied care based on their answer, as federal law protects all patients' access to healthcare. "This order should not impact anybody's access to care—period," Donatti added. The ACLU is reportedly considering legal action against Abbott's order, according to the Border Report.
The THA also assured Texans that the new rule would not compromise the quality of care. THA spokesperson Carrie Williams explained that hospitals across the state are working on processes to meet compliance standards without disrupting care.
Abbott's order applies only to hospitals enrolled in Medicaid or the Children's Health Insurance Program, which are required to submit this data quarterly to the state's Health and Human Services Commission, with the first report due by March 1, 2025.
The government requirement is part of a broader trend among Republican-led states to implement stricter immigration policies in healthcare facilities. The DeSantis administration in Florida enacted a similar directive that mandates hospitals accepting Medicaid to inquire about patients' immigration status, prompting advocacy groups like the "We Are Florida Coalition" to promote a "Decline to Answer" campaign, since patients are not compelled to respond.
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