Texas Hospitals Face Rising Costs for Undocumented Patient Care

New data reveals Texas hospitals incurred significant costs treating undocumented patients, sparking debate about financial responsibilities and healthcare access. The figures, however, lack crucial context regarding payments made.

Reported Costs Versus Actual Payments

Texas hospitals provided nearly 80,000 visits to undocumented patients between December 2024 and February 2025, totaling $329 million, according to data from the Texas Health and Human Services Commission. This represents approximately 2% of all patient visits during that period.

However, this figure does not account for any payments made by the patients themselves, according to an HHSC spokesperson, highlighting a significant gap in the data. The agency said it does not have data on payments.

Advocates Question Data’s Context

“We knew it wouldn’t give us good data,” said Lynn Cowles, health and food justice programs manager at Every Texan. Cowles argues the data release reflects an intention to create an unfriendly environment for immigrants.

**Abbott**’s Order and Federal Reimbursement

Last year, Gov. Greg Abbott ordered Texas hospitals to inquire about patients’ legal status, asserting that these costs burden the state’s healthcare system. His order suggests the federal government should reimburse Texas for costs related to its border policies.

The data excludes costs for uninsured, lawfully present Texas residents. Policy analysts suggest this cost is likely far greater, considering Texas’ high uninsured rate. Data indicates 3.1 million lawfully-present patients visited hospitals during the same period, but the number of uninsured is not specified.

Citizenship Question Concerns

Advocacy groups emphasize patients are not obligated to answer the citizenship question. Hospital officials assured that treatment will not be denied based on immigration status. In April, hospitals initially reported incurring $121.8 million in costs during November 2024, later adjusted to $118 million.

Uninsured Rates and Impact

Undocumented immigrants often use hospitals less than uninsured citizens due to lack of access to health insurance plans and Medicaid. Texas hospitals spend $3.1 billion annually on uncompensated care for the uninsured, according to the Texas Hospital Association.

In 2023, 8.7% of people in the United States, or 28.3 million, did not have health insurance at any point during the year, highlighting the broader challenge of healthcare access.

Who Comprises the Uninsured?

Charles Miller, a former Abbott advisor with Texas 2036, estimates that roughly 15% (about 730,000) of Texas’ uninsured are non-citizens without lawful permanent resident status. Miller noted that legally present individuals constitute the majority of the uninsured population in Texas.