AUSTIN, TX — Texas hospitals reported over $121 million in healthcare expenditures for undocumented immigrants in November 2024, marking the first data release under Governor Greg Abbott’s executive order mandating the tracking of such costs. The directive, issued on August 8, 2024, requires public hospitals to collect and report quarterly data on inpatient and emergency care provided to individuals lacking legal immigration status.
The Texas Health and Human Services Commission (HHSC) released the initial findings in April 2025, revealing that more than 31,000 visits from undocumented patients occurred in November alone. Of the total expenditures, approximately $85 million were attributed to inpatient discharges, while nearly $37 million covered emergency department visits. Notably, around $25 million of these costs involved patients enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) .
Governor Abbott’s executive order, known as GA-46, stipulates that hospitals begin collecting relevant data by November 1, 2024, with the first quarterly reports due by March 1, 2025. Annual summaries are to be submitted starting January 1, 2026. The governor has framed this initiative as a response to what he terms the “Biden-Harris Administration’s reckless open border policies,” asserting that Texas should not bear the financial burden of healthcare for undocumented immigrants .
Under the order, hospitals are instructed to inquire about a patient’s citizenship or immigration status during the intake process. However, patients are not obligated to respond, and their decision will not affect the care they receive. This approach aims to balance data collection with compliance to federal laws that mandate emergency medical treatment regardless of immigration status .
The policy has sparked significant debate among healthcare professionals, legal experts, and immigrant advocacy groups. Critics argue that the requirement may deter undocumented individuals from seeking necessary medical care, potentially exacerbating public health issues. Kassandra Gonzalez, a staff attorney with the Texas Civil Rights Project, expressed concern that the order could “discourage migrants from seeking emergency medical care due to fear of being questioned about their immigration status,” thereby violating the trust between patients and healthcare providers .
Healthcare providers have also voiced apprehension about the administrative burden and potential ethical dilemmas posed by the order. Dr. Andrea Green, an emergency physician in El Paso, noted that while the process is primarily about data collection, it introduces complexities in patient interactions. “We rarely get any decline to answer,” she said, highlighting the sensitive nature of the inquiries .
Despite these concerns, the Texas Hospital Association emphasized that hospitals are legally required to provide care to all patients, regardless of their immigration status or ability to pay. The association stated that the data collection should not deter individuals from seeking medical attention, reaffirming their commitment to serving the acute care needs of all Texans .
The financial implications of the executive order are substantial. Texas has one of the highest uninsured rates in the nation, with approximately one in six residents lacking health coverage. This contributes to an estimated $3.1 billion in annual unreimbursed healthcare costs across the state. Governor Abbott’s administration aims to use the collected data to seek federal reimbursement, arguing that the costs incurred are a direct result of federal immigration policies .
As the state moves forward with implementing the executive order, the broader implications for public health, hospital operations, and immigrant communities remain a subject of ongoing scrutiny and debate. The first comprehensive annual report, due in January 2026, is expected to provide further insights into the financial impact and effectiveness of the policy.