Texas Hospitals Must Ask Patients About Their Citizenship Status
In August, Texas Governor Greg Abbott issued an Executive Order (GA-46) directing the Texas Health and Human Services Commission (HHSC) to start collecting information on patients who are not lawfully present in the United States and assess costs to the Texas public hospital system.
“Texas will hold the Biden-Harris Administration accountable for the consequences of their open border policies, and we will fight to ensure that they pay back Texas for their costly and dangerous policies,” said Governor Abbott. The Executive Order took effect on November 1, 2024.
While the Executive Order specifically mentions public hospitals, most private hospitals in Texas must also comply with this new requirement. The Executive Order states that hospitals covered by the executive order include acute care hospitals enrolled in Medicaid or the Children’s Health Insurance Program (CHIP), and the order also applies to other healthcare providers identified by the Health and Human Services Commission. Any hospital that fails to comply with the Executive Order could potentially be expelled from the Medicaid and CHIP programs.
Since the effective date, Texas hospitals have been required to ask all patients about their citizenship status, but also inform them that their responses will not affect the care provided. Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals with emergency departments are required to screen patients and provide stabilizing care for emergency medical conditions regardless of the patient’s ability to pay. EMTALA applies regardless of the answer provided, including if the patient chooses not to answer the question.
Hospitals must submit reports to HHSC detailing the number of inpatient discharges and emergency visits and the cost of providing care. Hospitals are required to submit their first report on the collected information to HHSC by March 1, 2025, followed by quarterly reports. Commencing January 1, 2026, annual reports must also be submitted to the Texas Governor, Lieutenant Governor, and the Speaker of the House on the preceding state fiscal year’s costs for inpatient and emergency care of patients not lawfully present in the United States as reported by hospitals.
