Texas hospitals must now ask patients if they are in the U.S. legally. Here’s how it works

Texas hospitals starting Friday must ask patients whether they are in the U.S. legally and track the cost of treating people without legal status under an order from Republican Gov. Greg Abbott that widens the state’s conflict with the Biden administration over immigration.

Critics worry the change could drive people away from hospitals in Texas, even though patients are not required to answer questions to receive care. The mandate is similar to a policy that debuted last year in Florida, where Republican Gov. Ron DeSantis has also frequently criticized the federal government’s handling of illegal U.S.-Mexico border crossers.

Hospitals in Texas have spent months preparing for the changes and trying to reassure patients that it will not affect their level of care.

Here’s what you need to know:

Under an 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 information, and hospital workers must tell them that their answers will not affect their treatment, as required by federal law.

Hospitals are not required to begin filing reports with the state until March. The initial version of the spreadsheet compiled by state health officials to track the data does not include fields for entering patient names or personal information.

Providers will complete a breakdown of inpatient and emergency room visits and document whether they are legally in the country, a citizen, or not legally in the United States.

The reports will also show costs for those covered by Medicaid or the Children’s Health Insurance Program, known as CHIP; and cost for patients without it.

“Texans should not bear the burden of financially supporting health care for undocumented immigrants,” Abbott said when announcing the new policy.

Florida passed a similar law last year. Health care advocates say the law has frightened immigrants with medical emergencies and led to fewer people seeking care, even from facilities not covered by the law.

Early data from Florida is, by the state’s own admission, limited. Data provided independently. Anyone can refuse to answer, and nearly 8% of people admitted to the hospital and about 7% of people who went to emergency departments from June to December 2023 chose that option, according to the Florida report. Less than 1% of people who went to the emergency room or were admitted to the hospital reported that they were in the United States “illegally.”

Immigrant and health care advocates have sought to educate the Texas public about their rights. In Florida, groups used text messages, posters and emails to spread the word. But lawyers there said concerns have persisted for about a year.

Health care providers received state guidelines and recommendations from the Texas Hospital Association.

“The bottom line for patients is that this does not change hospital care. Texas hospitals continue to be safe places to provide needed care,” said Carrie Williams, spokeswoman for the hospital association.