Texas hospitals to start checking citizenship status this week

AUSTIN (Nexstar) -- This Friday, Texas hospitals will be required to collect information regarding patients who are not legally in the country as part of an executive order from Gov. Greg Abbott.

Abbott signed the order in August in an effort to collect data on the costs of caring for undocumented patients, claiming Texas "absorbs a large percentage of the costs associated with medical care for individuals who are not lawfully in the United States."

The order also directs hospitals to inform patients that their response "will not affect patient care."

Texas has the highest uninsured rate in the nation at 17% -- more than double the national average. Five million Texans have no insurance, the Texas Hospital Association reported. Last year, hospitals provided more than $8 billion in "charity care" for uninsured people, with more than $3 billion not reimbursed.

Most uninsured Texans are citizens, however. While 1.6 million undocumented immigrants live in Texas, they go to the hospital at lower rates than U.S. citizens and make up a minority of the uninsured cost burden on state hospitals, the Texas Tribune reported.

The American Civil Liberties Union of Texas worries the order will discourage undocumented Texans from seeking necessary medical care. They stress that patients do not need to answer the question, and cannot be denied care no matter their answer.

"This order should not impact anybody's access to care -- period," senior staff attorney with the ACLU of Texas David Donatti said. "Whether you are native-born, a U.S. citizen, an immigrant, whatever your status should be, you should be able to access the healthcare that you need and the facility should not have the ability to block you from receiving that kind of care. That is crystal clear as a matter of federal law."

Donatti said the ACLU is exploring possible legal action against the Governor's order.

The Texas Hospital Association also reassures patients that the new rule will not impact healthcare access.

"The bottom line for patients is that this doesn’t change hospital care. Texas hospitals continue to be a safe place for needed care," Texas Hospital Association spokesperson Carrie Williams told Nexstar. "On the particulars of implementation, all hospitals are different. Hospitals across the state are working on the backend to determine how to comply with the reporting guidance and meet the state’s deadlines."

The order applies only to hospitals enrolled in Medicaid or the Children's Health Insurance Program. Those facilities are required to report their data to the Health and Human Services Commission each quarter, with the first submission due March 1, 2025.