"Tens of Thousands" of Undocumented Patients Cost Texas Hospitals "Millions," Per State Official

A Texas state employee testified before the House Public Health Committee on Monday, revealing that "tens of thousands" of uninsured non-U.S. citizens received treatment in state hospitals in recent months, costing taxpayers millions of dollars.

The disclosure lacks exact numbers and dollar amounts—data that was supposed to be available by March 1, a deadline given by Gov. Greg Abbott last summer when he ordered Texas hospitals that accept Medicaid or the Children's Health Insurance Program (CHIP) to begin asking patients about their citizenship or immigration status starting in November 2024.
According to The Texas Tribune's coverage of the Monday committee hearing, 558 hospitals responded to the order, submitting the data they gathered over the past few months. However, the data lacks consistency, with some hospitals submitting handwritten documents that had to be manually entered.

"The number of visits was in the thousands, the tens of thousands, and the costs were in the millions," said Victoria Grady, director of provider finance at HHSC, during the hearing, adding that the data should be finalized by the end of the week.

Abbott signed the order in August, claiming that Texas "absorbs a large percentage of the costs associated with medical care for individuals who are not lawfully in the United States."

Despite the policy, hospitals are required to assure patients that their citizenship status will not affect their access to care. Advocacy groups, including the American Civil Liberties Union (ACLU), have emphasized that while hospitals must ask the question, patients can refuse to answer or state that they do not wish to respond.

During Monday's hearing, the House Public Health Committee reviewed a legislative proposal from state Rep. Mike Olcott, R–Fort Worth, that would officially require hospitals to submit an annual report, streamlining the process similarly to how the state of Florida did back in 2023.

Olcott emphasized the effect of "uncompensated care" on "small rural hospitals," claiming that 181 of them have closed since 2005 due to non-paying patients. "The goal of this is simply to know what percentage of that uncompensated care is due to people here illegally," he explained.

Those opposing the order and the legislative proposal argue that the bulk of uncompensated care comes from uninsured American citizens.

With the highest uninsured rate in the nation at 17%, Texas has approximately five million residents without health insurance, the Texas Hospital Association (THA) reported. In 2023, hospitals provided over $8 billion in care for the uninsured, with more than $3 billion remaining unreimbursed. However, most uninsured Texans are citizens.