Texas reports $1 billion in hospital care for undocumented patients in first year of tracking

New State Data Reveals Staggering Costs

Texas hospitals have been tracking healthcare costs for undocumented immigrants since November 2024.

The numbers are now in, and they are eye-opening. Over a ten-month period, hospitals across the state reported more than $1 billion in care for patients without legal immigration status. The data covers everything from emergency room visits to long hospital stays.

Governor Greg Abbott ordered the tracking, and he wants the federal government to pay Texas back.

However, experts caution that these figures represent total costs incurred, not necessarily uncompensated care, since some patients may have paid out-of-pocket or through other coverage.

Abbott Ordered the Tracking in 2024

In August 2024, Governor Abbott issued an executive order directing the Texas Health and Human Services Commission to collect information on undocumented immigrants who use Texas hospitals for inpatient and emergency care.

The order requires hospitals to collect information on the costs of care starting November 1, 2024, with quarterly reports due beginning in March 2025.

Hospitals must also tell patients that their answers about immigration status will not affect the care they receive, as required by federal law.

313,742 Visits Cost $1.05 Billion

The data spans ten months of fiscal year 2025, from November 2024 through August 2025. Because reporting only began in November, the first two months of the fiscal year (September and October) are not included, meaning these figures represent partial-year data.

Statewide totals show 313,742 hospital visits from patients not legally present in the U.S., costing hospitals $1.05 billion during the reporting period. The largest share of the expense, more than $565 million, came from inpatient discharges for patients not covered by Medicaid or CHIP.

The state has noted these figures remain subject to change as hospitals update their submissions, and many patients declined to answer the immigration question, potentially making the data incomplete.

Winter Was the Most Expensive Season

By quarter, the greatest number of visits was reported between December and February of last year, totaling 149,619 and costing more than $330 million.

That three-month stretch alone accounted for nearly a third of all the costs reported in the ten months.

The surge came during what are typically colder months when respiratory illnesses and other health issues spike across the general population.

Old Estimates Already Look Too Low

In 2021, Attorney General Ken Paxton estimated Texans were paying between $579 million and $717 million annually in uncompensated care for undocumented immigrants. The partial fiscal year 2025 totals alone already surpass that range.

Paxton’s office had also estimated Texans paid $152 million to house undocumented immigrants in jails for one year, plus $62 million to $90 million for the state Emergency Medicaid program.

The new hospital data suggest earlier projections underestimated the burden.

Abbott Wants Federal Money Back

Abbott maintains that the federal government should reimburse Texas for all costs associated with what he calls Biden administration open border policies.

The order states that current federal law contributes to the growth of uncompensated medical costs by requiring that any individual must be allowed to obtain emergency medical treatment, regardless of immigration status or ability to pay.

Whether Texas can actually collect remains uncertain.

Federal Law Requires Emergency Care

The Emergency Medical Treatment and Active Labor Act, passed in 1986, requires hospital emergency departments that accept Medicare payments to provide medical screening and stabilizing treatment to anyone seeking care, regardless of citizenship, legal status, or ability to pay.

Because there are very few hospitals that do not accept Medicare, the law applies to nearly all hospitals in the country.

Hospitals cannot turn patients away, even if they know they will not be paid.

Texas Costs Dwarf Florida Numbers

Abbott issued the hospital directive about 15 months after Florida Governor Ron DeSantis signed similar legislation in May 2023.

Texas reported costs more than quadruple what Florida hospitals reported for 2024.

Florida reported total healthcare costs of nearly $660 million in 2024 for patients not lawfully present, though that figure does not account for how many immigrants paid their own bills.

Texas shares a much longer border with Mexico, which helps explain the gap.

Patients Do Not Have to Answer

The executive order requires hospitals to ask about a patient’s citizenship or immigration status, but it does not require the patient to answer. Federal privacy law prohibits the disclosure of protected health information without authorization from the patient.

Policy analysts have said they worry the figures would come with many caveats, since many patients decline to respond to the citizenship question.

Rural Hospitals Already Struggling

According to the Texas Hospital Association, twenty-one rural hospitals in Texas have closed in the last decade, more than any other state. Texas has the highest uninsured rate among all states, with nearly one in five residents living without insurance, more than double the national average.

A mid-2025 report from the Center for Healthcare Quality and Payment Reform estimates 87 rural Texas hospitals are at risk of closure, and 22 face immediate risk of shutting down.

Uncompensated care is one of several factors pushing these facilities toward collapse.

Border Crossings Have Plummeted

Unlawful crossings along the U.S.-Mexico border in fiscal year 2025 plummeted to the lowest annual level since the early 1970s amid the Trump administration’s immigration crackdown.

Border Patrol agents recorded nearly 238,000 apprehensions of migrants crossing the southern border illegally in fiscal year 2025, the lowest annual tally since 1970.

The drop means future hospital costs from new arrivals may decline, though the existing undocumented population will still need care.

Texas Carries a Heavy Healthcare Load

The Texas Hospital Association estimates that hospitals spend $3.1 billion per year on care that is not reimbursed.

Nearly 22% of Texas adults aged 19 to 64 lacked health insurance in 2023, almost double the national average.

The $1 billion in costs reported for undocumented patients is a significant slice, representing roughly one-third of total uncompensated care, but uncompensated care from uninsured citizens adds billions more.

Texas hospitals are caught between federal mandates to treat everyone and a state that has not expanded Medicaid.

This article was created with AI assistance and human editing.

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