Starting Friday, Texas hospitals will be required to ask patients whether they are in the U.S. legally and track the cost of treating undocumented people. This follows an executive order from Republican Gov. Greg Abbott that deepens the state’s conflict with the Biden administration over immigration.
Critics worry the change could scare people away from hospitals in Texas, even though patients don’t have to answer the questions to receive medical care. The mandate is similar to a policy introduced last year in Florida, where Republican Gov. Ron DeSantis has also frequently criticized the federal government’s handling of illegal border crossings along the U.S.-Mexico border.
Hospitals in Texas have been preparing for the change for months, trying to reassure patients that it will not impact their level of care.
Here’s what you should know:
Required to ask, not required to answer
Under the executive order announced by Abbott in August, hospitals must ask patients whether they are U.S. citizens and whether they are in the country legally.
Patients have the right to withhold the information and hospital staff must tell them that their answers will not impact their care, as required by federal law.
Tracking hospital costs and patient information
Hospitals don’t have to start submitting reports to the state until March. An early draft of a data tracking spreadsheet created by state health officials did not include fields for entering patient names or personal information.
Providers complete a breakdown of inpatient and emergency patient visits and document whether they are in the country legally, a citizen or not
The reports also detail costs for those covered by Medicaid or the Children’s Health Insurance Program, known as CHIP. and the costs for patients without them.
“Texans should not have to bear the burden of financially supporting medical care for illegal immigrants,” Abbott said in announcing the policy.
Texas is following Florida’s example
Florida passed a similar law last year. Health care advocates say the law has instilled fear in immigrants in need of emergency medical care and led to fewer people seeking support, even at facilities not subject to the law.
The initial data from Florida is – according to the state’s own information – confined. The data is self-reported. Anyone can decline to respond, an option chosen by nearly 8% of people hospitalized and about 7% of people who went to the emergency room from June to December 2023, according to Florida’s state report. Less than 1% of people who went to the emergency room or were hospitalized said they were in the U.S. “illegally.”
Hospitals in Texas have prepared
Immigration and health care advocates have tried to educate the Texas public about their rights. In Florida, groups used text messages, posters and emails to spread the word. But advocates there said they hadn’t seen fears subside for about a year.
Health care providers received instructions from the state and guidance from the Texas Hospital Association.
“The bottom line for patients is that this will not change hospital care. “Texas hospitals continue to be a safe place to get needed care,” said Carrie Williams, spokeswoman for the hospital association.
