Undocumented patients skip care

Gov. Greg Abbott’s Executive Order GA‑46 was announced Aug. 8, 2024 and went into effect Nov. 1, 2024, directing the Texas Health and Human Services Commission to require Medicaid‑participating acute care hospitals to collect patients’ citizenship or lawful‑presence status and report aggregate counts and costs to the state. (gov.texas.gov (gov.texas.gov)). (gov.texas.gov) HHSC data released to media show 12,647,958 emergency‑department visits and inpatient discharges were recorded after the rule took effect, with self‑reported nonlawful patients constituting a small share of that total and the state publishing quarterly cost tallies derived from hospital reports. (kxan.com (kxan.com)). (kxan.com) Local reporting and the Tribune’s analysis identify a tracked decline in self‑reported undocumented patient visits from roughly 30,000 in November 2024 to about 20,345 by August 2025, a 32% drop, while visits by patients who said they were legally present rose about 14% over the same period. (kvue.com (kvue.com)). (kvue.com) The declines were uneven: hospitals near the U.S.‑Mexico border reported some of the steepest decreases — in some facilities patient counts of those self‑identifying as undocumented fell by more than half — a pattern documented in state and local coverage. (houstonpublicmedia.org (houstonpublicmedia.org)). (houstonpublicmedia.org) Reporting behavior mattered: about 11.3% of patients have declined to answer the citizenship question since reporting began, and self‑identified undocumented patients made up roughly 2% of all reported visits statewide, with dozens of hospitals reporting zero undocumented patients in submitted quarters. (kxan.com (kxan.com)). (kxan.com) Hospitals and state officials say the collection is statistical and that identifying details are not transmitted to the governor’s office, while civil‑rights groups and legal observers have flagged HIPAA and patient‑privacy concerns and emphasized that patients cannot be forced to answer. (texasstandard.org (texasstandard.org); aclutx.org (aclutx.org)). (texasstandard.org) State releases of hospital cost data show large headline figures — including reports of roughly $121 million in care for undocumented patients in November 2024 and aggregated state tallies exceeding $1 billion for the first year of tracking — figures that public‑health analysts say lack breakdowns on payment, reimbursement or uncompensated‑care context. (thehouston.org (thehouston.org); texasscorecard.com (texasscorecard.com)). (thehouston.org)