Texas hospitals must now ask patients whether they’re in the US legally. Here’s how it works

Austin, Texas (AP) – Texas hospital patients will be asked if they’re in the US legally starting Friday.

The new policy stems from an order by Republican Gov. Greg Abbott, and it escalates the state’s clash with the Biden administration over immigration. Abbott intends for hospitals to track spending on patients who aren’t legal residents so the state can try to recover the money from the federal government. Critics believe the new questions could scare people away from seeking critical medical care, even though patients are allowed to say they don’t want to answer.

The mandate is similar to a policy that debuted last year in Florida, where Republican Gov. Ron DeSantis has also been a frequent critic of the federal government’s handling of illegal crossings along the US-Mexico border.

Florida hospitals were ordered to start asking questions about immigration status last year, which critics say provoked confusion and fear within immigrant communities.

Texas hospitals have spent months preparing for the change and have sought to reassure patients it won’t affect their level of care.

Here’s what to know:

Under the executive order announced by Abbott in August, hospitals must ask patients if they are citizens in the US and whether they are lawfully present in the country.

Patients have the right to withhold the information, and hospital workers must tell them their responses will not affect their care, as required by federal law.

Tracking hospital costs and patient data

Hospitals are not required to begin submitting reports to the state until March. An early draft of a spreadsheet made by state health officials to track data does not include fields to submit patient names or personal information.

Providers will fill out a breakdown of visits by inpatient and emergency care patients and document whether they are lawfully present in the country, citizens or not lawfully present in the US.

The reports will also add up costs for those covered by Medicaid or the Children’s Health Insurance Program, known as CHIP, and the cost for patients without it.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Abbott said when he announced the policy.

Health care advocates in Florida contend the law has made immigrants in need of emergency medical care fearful and led to fewer people seeking help, even from facilities not subject to the law.

Florida’s early data is — by the state’s own admission — limited. It’s self-reported. Anyone can decline to answer, an option chosen by nearly 8% of people admitted to the hospital and about 7% of people who went to the emergency room from June to December 2023, according to Florida’s state report. Fewer than 1% of people who went to the emergency room or were admitted to the hospital reported being in the US “illegally.”

Immigrant and health care advocates have sought to educate the Texas public about their rights. In Florida, groups used text messages, posters and emails to get the word out. But advocates there have said they didn’t see fears subside for about a year.

Health care providers received directives from the state and guidance from the Texas Hospital Association.

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