Texas has put a hard number on one of the state’s most politically charged debates, and it is not a small tab. Newly released data show hospitals reported more than 313,700 visits by patients described as “not legally present” in fiscal year 2025, tied to roughly $1.05 billion in health care costs. The total is the first annual figure produced under Gov. Greg Abbott’s new hospital-reporting order and does not include September and October of FY2025, since hospitals were only required to begin asking about immigration status in November 2024. The tally lands right in the middle of ongoing fights over border operations and how Texas spends its health care dollars.
What the state numbers show
According to a GA-46 FY2025 spreadsheet reproduced by Texas Scorecard, Texas hospitals logged 313,742 visits by patients labeled “not legally present,” with reported costs totaling $1,050,642,864. The same table splits the sum into major categories, including roughly $565.4 million tied to inpatient discharges for non-Medicaid and non-CHIP patients and about $205.5 million in non-Medicaid emergency department visits.
The spreadsheet also notes that the figures can change as hospitals update or correct their submissions. Local coverage that reviewed the Texas Health and Human Services Commission totals landed on similar statewide numbers, as reported by KVUE.
How the data were collected
Abbott’s Executive Order GA-46 requires hospitals that participate in Medicaid and the Children’s Health Insurance Program to ask patients whether they are lawfully present in the United States, then report certain encounters and costs to the Texas Health and Human Services Commission on a quarterly basis. Guidance from the Texas Health and Human Services Commission set November 1, 2024, as the start date for data collection, March 1, 2025, as the deadline for the first quarterly reports, and January 1, 2026, as the target for the agency’s first annual report to state leaders.
Hospitals are required to track inpatient discharges, emergency room visits and associated costs for patients who are reported as “not legally present,” then feed that information into the GA-46 reporting system.
Advocates warn of a chilling effect
Immigrant-rights advocates and some public health experts have warned that asking patients about immigration status at the hospital door could scare people away from getting care in the first place. The ACLU of Texas stresses that patients are allowed to decline to answer the question and that federal law still requires hospitals to provide emergency treatment regardless of immigration status.
Policy analysts at KFF note that similar reporting rules in other states have been associated with lower use of some health services, which they say can carry potential public health consequences if people delay or avoid medical care.
Hospitals push back and data carry caveats
The Texas Hospital Association says its members have complied with the executive order while trying to reassure patients that care comes first. In a public statement, the association said hospitals "are the epicenter of health, safety and healing for people who need it most" and urged that any state policy include safeguards so people are not discouraged from seeking treatment.
The GA-46 spreadsheet itself labels the numbers as provisional, meaning the $1.05 billion figure could shift as hospitals submit late reports or correct earlier data. The Texas Hospital Association also emphasized that federal rules require hospitals to ensure that how a patient answers the immigration-status question, or whether they answer it at all, cannot affect the care they receive.
Why this is news now and what to watch
The timing traces back to the GA-46 calendar. The order set January 1, 2026, as the deadline for the first annual report, which is why this is the first time statewide totals have been fully compiled and released under the new system. The numbers are likely to feature heavily in coming debates over border policy, hospital finances, and the state’s role in covering uncompensated care.
Going forward, lawmakers, hospital finance officers, and immigrant advocates will be watching the next rounds of quarterly reports and any legislative proposals that could change the reporting rules, adjust privacy protections, or reshape how the state helps pay for hospital costs tied to patients labeled “not legally present.”
