Texas hospitals incurred more than $1 billion in health care costs for patients not lawfully present in the United States during fiscal year 2025, according to new data obtained from the Texas Health and Human Services Commission.
The figures were collected under an executive order issued by Gov. Greg Abbott in August 2024, which requires hospitals to report the cost of inpatient and emergency care provided to individuals in the country illegally. Under Abbott’s order, hospitals are also required to inform patients that responses regarding immigration status will not affect their care, as required by federal law.
Statewide totals show 313,742 hospital visits from patients not legally present in the U.S., costing hospitals $1.05 billion during the reporting period. The largest share of the expense—more than $565 million—came from inpatient discharges for non-Medicaid and non-CHIP patients.
Emergency department visits accounted for roughly $230 million, while total inpatient care exceeded $820 million, underscoring that long-term hospitalizations, not emergency treatment alone, are driving much of the cost.
Although hospitals are required under federal law to deliver the care, unpaid medical costs are ultimately passed along to Texans. Taxpayers absorb the burden through higher insurance rates, public hospital funding, and state health programs.
Notably, the data does not reflect a full fiscal year of mandatory reporting. Hospitals were only required to begin submitting data in November 2024, leaving the first two months of fiscal year 2025—September and October—unreported.
HHSC has also noted that the figures remain subject to change as hospitals update their submissions.
Even with those limitations, the reported costs far exceed earlier estimates.
In 2021, Attorney General Ken Paxton estimated Texans were paying between $579 million and $717 million annually in uncompensated care for illegal aliens. The partial FY 2025 totals alone already surpass that range.
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