Texas hospitals on Friday began collecting new information from its patients. They are now required to ask patients about their legal status as an American citizen.
Public health officials say the new state mandate asking about a patient’s immigration status will not impact patient care or treatment.
Gov. Greg Abbott’s executive order requires that hospitals now report the costs of treating undocumented immigrants.
Officials at University Health System, Baptist Health System, CHRISTUS Health System and Methodist Healthcare told the San Antonio Report its hospitals are complying with the governor’s order.
During the intake process, the question is posed in the following way: Are you a United States citizen or lawfully present in the United States, or are you undocumented and not lawfully present in the U.S.?
According to the Texas Health and Human Services Commission, hospitals must report how many undocumented patients get care at their emergency departments per month and also how many patients decline to respond.
Hospitals must also report the number of all inpatient discharges by legal status, as well as ER visit costs not charges, and inpatient discharge costs for undocumented patients, even if those patients pay cash.
The data must be reported to the HHSC quarterly with the first report due March 1, and every three months thereafter.
After the Jan. 1, 2026 report, the HHSC will provide the report on costs to Abbott, the Lieutenant Governor and to the Speaker of the House.
“The bottom line for patients is that this doesn’t change hospital care,” said Texas Hospital Association’s spokeswoman Carrie Williams. “Texas hospitals continue to be a safe place for needed care.”
She said hospitals across the state are working on the backend to determine how to comply with the reporting guidance and meet the state’s deadlines.
According to the HHSC, hospitals must tell their patients that their response to the citizenship question will not affect their medical care.
Edith Reyes was walking out of the emergency department at University Hospital on Monday while her husband was in surgery. She said she wasn’t with him during the intake process, but said her family was aware the question would be asked beforehand.
She said she believes the timing of the executive order being rolled out so close to Election Day will make undocumented communities much more hesitant to visit hospitals.
“There’s people that don’t go to the hospitals because of lack of insurance. People don’t already go because of insurance and how much it costs, and now with this, even less. If I was undocumented, I would suffer through it,” she said.
Reyes said she worries the order could cause negative, long-term health implications for immigrant communities, like putting off chest pain and ignoring symptoms.
A few minutes later, Erlan R. walked into the emergency room with an eye injury. An undocumented immigrant from Honduras, now living in San Antonio and working as a roofer, he said he was unaware of the new executive order requiring him to disclose his legal status.
He described being nervous to seek care to begin with, but ultimately decided he should to go to the hospital because of the pain.
“I feel nervous to say I’m undocumented,” he said in Spanish. “When it’s about health, that shouldn’t matter because when someone feels sick, they have to seek care.”
Several groups, including the San Antonio Metropolitan Health District, are working to make sure anyone who seeks care at local hospitals know about their rights.
The League of United Latin American Citizens (LULAC) is also advising Latino communities that they have no obligation to disclose their legal status and that refusing to respond is not a crime.
LULAC is encouraging immigrant communities to seek medical care if needed, and is reassuring people that the executive order will not interrupt undocumented patients’ medical care.
“If you are Hispanic or undocumented, remember that you contribute taxes, which help support hospitals,” LULAC said in a statement. “You are not receiving free care; tax dollars fund these institutions for everyone.”
