Texas hospitals will be required to ask patients starting Friday about their legal status in the U.S. and keep track of the costs associated with treating those without legal status, following a directive from Republican Governor Greg Abbott. This new regulation heightens tensions between the state and the Biden administration over immigration issues. Critics express concerns that this initiative may deter individuals from seeking necessary medical care in Texas, despite patients having the option not to respond to such inquiries for health services.

This mandate mirrors a similar policy implemented in Florida last year under Governor Ron DeSantis, who has also voiced strong opposition to the federal government’s approach to immigration enforcement and the management of illegal crossings at the U.S.-Mexico border. Texas hospitals have been proactively preparing for this requirement and have been working to reassure patients that their care quality will remain unchanged.

Here are the important details to understand:

**Mandatory Questions, Optional Responses**

According to an executive order issued by Governor Abbott in August, hospitals are now obliged to ask patients whether they are U.S. citizens and if they are legally present in the country. Patients have the right to remain anonymous regarding their immigration status, and healthcare staff are required to inform them that their answers will not impact the quality of care they receive, as mandated by federal guidelines.

**Monitoring Healthcare Expenses and Patient Information**

Hospitals will not have to start submitting financial reports to the state until March, allowing them time to adapt to the new requirements. A preliminary version of a data tracking tool created by state health officials indicates that it will not require specific details such as patients’ names or personal identifiers. Instead, hospitals will provide general statistics on the number of inpatient and emergency room visits, including the legal status of the patients on record. The report will detail costs associated with those covered by Medicaid or the Children’s Health Insurance Program (CHIP), as well as expenses for uninsured patients.

Abbott expressed that “Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants” when unveiling this policy.

**Texas Follows Florida’s Example**

Florida implemented a comparable law the previous year, with health advocates arguing that it has resulted in immigrants postponing or avoiding emergency care out of fear, impacting their willingness to seek help even at facilities not bound by the regulation.

According to Florida’s government, their initial data is sparse and heavily relies on self-reports. During a period from June to December 2023, approximately 8% of individuals admitted to hospitals, and 7% of those visiting emergency rooms chose not to answer the citizenship questions. Less than 1% of those who accessed emergency services or were hospitalized reported being in the U.S. illegally.

**Texas Hospitals’ Preparations**

Advocates for immigrants and healthcare have been active in informing the public about their rights in Texas. In Florida, organizations employed a variety of outreach methods, including text messages, posters, and emails, to spread awareness. However, these advocates noted that substantial fear among immigrant communities took almost a year to mitigate. Meanwhile, Texas healthcare providers have been given instructions from state officials along with guidance from the Texas Hospital Association.

Carrie Williams, spokesperson for the hospital association, emphasized, “The bottom line for patients is that this doesn’t change hospital care. Texas hospitals continue to be a safe place for needed care.”