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Texas hospitals incurred $121.8 million in health care costs in November from patients who were not “lawfully” permitted to be in the country, according to data released by the Texas Health and Human Services Commission on Friday.

Hospitals throughout Texas reported to the state health agency the cost of more than 30,000 hospital visits by undocumented immigrants after Gov. Greg Abbott ordered Texas hospitals to ask all patients starting Nov. 1 to disclose whether they were “lawfully in the United States.” Abbott stated in the order that the purpose of the report was to hold the Biden-Harris administration accountable for its open border policy and to demand federal reimbursement for the costs of care. He alleged in his order that undocumented immigrants increase the costs of medical care for all Texans.

“Now, Texas has reliable data on the dramatic financial impact that illegal immigration is having on our hospital system,” said Andrew Mahaleris, Abbott’s press secretary, in an emailed statement on Friday.

Policy analysts have previously told The Texas Tribune that they worry the figure the state would release on undocumented immigrants’ hospital costs would come with many caveats.

Friday’s report did not say how the costs from undocumented patients, who typically don’t have health insurance, compare to that of uninsured U.S. citizens who used the Texas hospital system during the month of November. The report also does not clarify whether any of the costs have or will be recouped by hospitals at a later time.

Lynn Cowles, health and food justice programs manager at left-leaning think tank Every Texan, said $121.8 million is a drop in the bucket compared to the incurred costs from all uninsured Texas citizens.

Texas has the highest uninsured rate in the country, according to recent estimates from the U.S. Census Bureau. About 4.8 million or 19% of Texas children and adults under the age of 65 lacked health insurance in 2023.

The state has 1.7 million undocumented immigrants.

“We don’t even know how much of our collective funds go to those who are documented compared to those who are undocumented. But we do know that the majority of uninsured people in Texas are citizens,” she said.

Patients are informed that they are not legally required to provide their citizenship status to the hospital and that their answers can not jeopardize their access to health care.

The Texas Hospital Association on Friday doubled down on hospitals’ promise to care for any Texans who need it.

“The fact that hospitals are required to collect this data should not be a deterrent for people in need of care,” according to the news release.

Immigration advocates fear that the risk of deportation could deter undocumented immigrants from responding to the question and from going to hospitals for care. That chilling effect contributes to why the data collected by hospitals is dubious, Cowles said.

“What happens to the data that doesn’t get filled out? There are a lot of Texas residents who refuse to fill out the immigration form. Does that get lumped in with this? There are a lot of questions when it comes to the report,” Cowles said.

Cowles said the 10-sentence report falls short of addressing what is driving up Texans’ health care costs.

“If this is a project to get good data, this is an unsuccessful project,” Cowles said.” What we need is a pilot study or a survey that really tries to grasp the entire pool of uncompensated care in Texas, because the real cost is coming from citizens, especially citizens in the rural areas where the uninsured rates are just so much higher.”

Data has shown for years that undocumented immigrants who lack access to health insurance plans, Medicaid included, typically use hospitals less than American citizens who are uninsured – Texas hospitals spend $3.1 billion a year on uninsured care that is not reimbursed, according to the Texas Hospital Association estimates. Even emergency Medicaid spending, which by design, covers undocumented immigrants’ hospital costs in limited circumstances, has gone down in the last five years.

State Rep. Mike Olcott, R-Fort Worth, who has filed House Bill 2587 that would codify Abbott’s order to ask for citizenship status of hospital patients, said that knowing the cost of undocumented patients is important amid the state’s struggle to keep rural hospitals open.

“Since 2005, we’ve had 181 small rural hospitals close primarily due to uncompensated care,” Olcott said Monday in a hearing on his bill. “The goal of this is simply to know what percentage of that uncompensated care are due to people here illegally.”

The report of a year’s worth of data collected from hospital providers on cost from undocumented immigrants is expected to be released at the start of 2026.

Disclosure: Every Texan and Texas Hospital Association have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

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