Texas public hospitals must now ask patients whether they are in the U.S. legally.

(HOUSTON) – Public hospitals in Texas will now be required to ask patients whether they are in the U.S. legally and keep records of money spent on undocumented migrants after an executive order took effect Friday.

State hospitals are required to collect information on the “cost of health care provided to undocumented immigrants,” the number of hospital discharges and the number of emergency room visits, and then report that data quarterly to the Texas Health and Human Services Commission. Gov. Greg Abbott wrote in an August statement announcing the measure.

Although facilities must ask patients about their legal status, patients are not required to answer.

The new policy will also apply to hospitals participating in Medicaid, the Children’s Health Insurance Program and any other facilities designated by the commission.

The first submission is due March 1, 2025, according to the governor’s office. The commission will then report annually, beginning January 1, 2026, to the governor, lieutenant governor, and speaker of the House on the total cost of health care provided to undocumented immigrants.

According to the order, patients should be advised that the collection of this information will not affect patient care. Federal law requires that patients be told that their answers will not affect their health care.

The order also states that the federal government “can and should be required to reimburse the State of Texas for the costs that its open border policies have imposed on Texans.”

“Because of President Joe Biden and Vice President Kamala Harris’ open border policies, Texas has had to pay medical costs for people in the state illegally,” Abbott said in a statement, even as encounters with migrants at the border began to rise while Donald Trump Trump was president for several months from April 2020 until the November election. “Texans should not shoulder the burden of financially supporting health care for undocumented immigrants.”

Immigration advocacy groups condemned the action when it took place on Friday.

“Abbott’s latest executive order, which goes into effect today and is contrary to federal law, is a calculated attempt to drive immigrants into the shadows and leave our communities fearful of being targeted in the very places where we should feel safe. Harassing immigrants in hospitals is just the first step toward Trump’s Project 2025 agenda, said Michelle Ming, political director of United We Dream Action, an immigrant advocacy group.

ABC News’ Armando Garcia contributed to this report.

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