Experts Cast Doubt on State’s Report That Undocumented Immigrants Cost Texas Hospitals $122M in a Month

“The fact that hospitals are required to collect this data should not be a deterrent for people in need of care,” according to the news release.

Immigration advocates fear that the risk of deportation could deter undocumented immigrants from responding to the question and from going to hospitals for care. That chilling effect contributes to why the data collected by hospitals is dubious, Cowles said.

“What happens to the data that doesn’t get filled out? There are a lot of Texas residents who refuse to fill out the immigration form. Does that get lumped in with this? There are a lot of questions when it comes to the report,” Cowles said.

Cowles said the 10-sentence report falls short of addressing what is driving up Texans’ health care costs.

“If this is a project to get good data, this is an unsuccessful project,” Cowles said.” What we need is a pilot study or a survey that really tries to grasp the entire pool of uncompensated care in Texas, because the real cost is coming from citizens, especially citizens in the rural areas where the uninsured rates are just so much higher.”

Data has shown for years that undocumented immigrants who lack access to health insurance plans, Medicaid included, typically use hospitals less than American citizens who are uninsured – Texas hospitals spend $3.1 billion a year on uninsured care that is not reimbursed, according to the Texas Hospital Association estimates. Even emergency Medicaid spending, which by design, covers undocumented immigrants’ hospital costs in limited circumstances, has gone down in the last five years.

State Rep. Mike Olcott, R-Fort Worth, who has filed House Bill 2587 that would codify Abbott’s order to ask for citizenship status of hospital patients, said that knowing the cost of undocumented patients is important amid the state’s struggle to keep rural hospitals open.

“Since 2005, we’ve had 181 small rural hospitals close primarily due to uncompensated care,” Olcott said Monday in a hearing on his bill. “The goal of this is simply to know what percentage of that uncompensated care are due to people here illegally.”

The report of a year’s worth of data collected from hospital providers on cost from undocumented immigrants is expected to be released at the start of 2026.

Stephen Simpson is the Texas Tribune’s mental health reporter. This story is published courtesy of the Texas Tribune.The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.