Texas Reports $329M Hospital Costs for Undocumented Patients With Limited Payment Data

Texas hospitals reported nearly 80,000 visits from undocumented patients between December 2024 and February 2025, incurring an estimated cost of $329 million. This represents about 2% of all hospital visits during this period. The Texas Health and Human Services Commission (HHSC) provided this data, which is part of ongoing efforts to assess healthcare costs associated with undocumented immigrants under Governor Greg Abbott's executive order requiring hospitals to inquire about patients' legal presence in the U.S.

However, the dataset lacks critical payment information, including how much of the incurred costs were actually paid by patients or other sources. HHSC confirmed they do not have data on payments made toward these costs. This limitation means the figures represent gross costs rather than net financial burdens borne by hospitals.

The report does not include comparable data on uninsured but lawfully present Texas residents, who likely represent a larger share of uncompensated hospital care, given Texas's high uninsured rate. Approximately 3.1 million legally present patients visited Texas hospitals during the same quarter, yet the proportion uninsured and associated costs remain unspecified.

Undocumented immigrants are ineligible for Medicaid, CHIP, Medicare, and Affordable Care Act plans but may have private insurance or pay out-of-pocket. Emergency Medicaid can cover certain hospital services for undocumented patients, but studies show this group generally uses emergency and hospital care less frequently than uninsured U.S. citizens. Texas hospitals incurred $3.1 billion annually in unreimbursed care for uninsured patients overall.

Policy analysts estimate that undocumented uninsured individuals compose about 15% of Texas's uninsured population, with the majority being legally present but uninsured. Texas's uninsured rate is the highest in the nation, with about 19% of residents under 65 lacking coverage as of 2023.

The data's voluntary nature and incomplete cost offsets have led advocacy groups to question its accuracy and the intent behind its release. Hospitals maintain that patient treatment is not interrupted based on legal status responses, which are voluntary. The data aims to inform policy discussions around healthcare costs associated with immigration status but requires more comprehensive contextualization to fully understand financial impacts on the Texas healthcare system.