Texas Hospitals to Inquire About Patient Citizenship Status Under New Executive Order

Texas Hospitals Face New Citizenship Query Requirement

Implementation and Compliance

As of November 1, 2024, an executive order signed by Texas Governor Greg Abbott mandates hospitals across the state to inquire about the citizenship status of patients. This requirement applies during admissions and emergency care, impacting facilities participating in Medicaid and the Children’s Health Insurance Program (CHIP), as well as other hospitals identified by the Texas Health and Human Services Commission.

The executive order is guiding hospitals to not only ask about citizenship but also to meticulously collect and submit data regarding the costs incurred while providing care to individuals not lawfully present in the United States. This data collection includes records of inpatient discharges, emergency visits, along with the financial encumbrances associated with these services. The submission of such data is mandated on a quarterly basis to the Texas Health and Human Services Commission.

Aim and Concerns

The stated aim of this directive is to compile comprehensive data regarding the expenses tied to medical care for undocumented immigrants, which Governor Abbott intends to leverage in seeking federal reimbursement. Despite this, the requirement has sparked concern among civil rights and immigration advocacy groups. They argue that the policy may instill fear among undocumented immigrants, potentially deterring them from pursuing necessary medical treatment.

Hospitals have attempted to alleviate these fears by reassuring patients that the quality and accessibility of care will remain unaffected, irrespective of their response to the citizenship question. Federal law mandates that medical treatment cannot be denied based on a patient’s immigration status or their ability to pay. This measure aims to preserve patient trust and ensure healthcare is accessible to all who need it.

Ongoing Challenges and Broader Implications

The executive order also stipulates that the initial data submissions from hospitals are due by March 1, 2025, with subsequent reports to be furnished quarterly. From January 1, 2026, an annual comprehensive report will be shared with Texas’s high-ranking officials, including the governor and the speaker of the house. This reporting is part of an ongoing evaluation of the state’s financial obligations related to unauthorized immigrant healthcare.

Beyond the immediate concerns surrounding healthcare access, this move underscores a broader tension between the state of Texas and federal immigration policies. Governor Abbott’s actions reflect frustration with what he perceives as federal mishandling of border security and immigration, positioning the executive order as a strategy to address fiscal pressures allegedly caused by these federal policies.

Preparation and Repercussions

In anticipation of these new requirements, hospitals in Texas have been diligently preparing to comply, balancing legal and operational readiness while emphasizing that patient care will remain unaffected. Legal advisors and administrative personnel have been actively engaged in training staff, ensuring both compliance with the new mandate and the maintenance of an environment where patients feel safe and respected irrespective of their immigration status.

While the implementation is poised to generate substantial fiscal data, its long-term impacts on public health and immigration policy remain to be seen. The reaction of community and advocacy groups will likely play a crucial role in shaping the discourse surrounding this and similar policies, as the state navigates the complexities of balancing enforcement and empathy in its approach to handling immigration-related health care challenges.