Texas hospitals reported nearly $121.8 million in healthcare expenses in a single month due to the treatment of individuals not lawfully present in the United States, according to a new report released by the Texas Health and Human Services Commission (HHSC). This marks the first data published under Governor Greg Abbott’s executive order requiring hospitals to track and disclose the costs of caring for undocumented immigrants.
The report, covering the month of November 2024, reveals that more than 31,000 hospital visits—including inpatient admissions and emergency room care—were attributed to patients classified as “persons not lawfully present in the U.S.” The total sum reflects the cost of services rendered, not necessarily what was reimbursed or paid.
Governor Abbott issued the executive order in August 2024, citing what he called the "fiscal and operational strain" placed on Texas hospitals due to federal immigration policy. The order directs all Texas public hospitals to collect and report data on the care provided to undocumented immigrants.
“This is a necessary step to hold the federal government accountable for the consequences of their open-border policies,” Abbott said at the time of the order. “Texans deserve to know how their hospitals and their tax dollars are being impacted.”
The HHSC clarified that reports will be published on a quarterly basis, with the first annual summary slated for release on January 1, 2026. While November’s $121.8 million figure offers only a snapshot, it underscores the magnitude of healthcare costs associated with undocumented immigrants in the state.
Broader National Context
The cost of providing healthcare to undocumented immigrants is a contentious topic across the country. A 2019 report by the Migration Policy Institute noted that over half of the U.S. unauthorized population—approximately 53%—lack health insurance, often relying on emergency services as a last resort for care.
In contrast to Texas’s crackdown, states like California have expanded healthcare access. Beginning in 2024, California became the first state to offer state-funded health coverage to income-eligible undocumented adults aged 26 to 49, with future annual costs projected at $2.7 billion, according to the state’s Legislative Budget Board.
Florida, another state tracking the costs of care for undocumented immigrants, reported $660 million in expenses in 2024 alone.
Policy Clash at the Federal Level
Texas’s reporting initiative arrives amid a larger national debate over who should receive publicly funded healthcare. While the Biden administration expanded healthcare access for DACA recipients, the Centers for Medicare & Medicaid Services announced in March that it would revert to a more restrictive interpretation of eligibility under a February executive order by former President Donald Trump. This order blocks undocumented individuals from receiving subsidized care under the Affordable Care Act unless they have legal status.
The Abbott administration's executive order references federal immigration trends, stating that more than 11 million people have entered the U.S. illegally in under four years.
Critics of the Texas policy argue that such directives may lead to fear among immigrant communities, potentially deterring people from seeking necessary medical treatment. Supporters, however, say the policy brings long-needed transparency to the cost burden carried by state and local governments.
For now, Texas officials say the data is just beginning to shed light on the scale of the issue. “This is the first step in understanding the true cost of illegal immigration on our healthcare system,” said an HHSC spokesperson. “And the numbers speak for themselves.”
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