AUSTIN (KXAN) More than 100,000 undocumented people sought medical care in Texas in the first four months that hospitals were required to ask every patient their immigration status but that represents a small fraction of all patients during that timeframe.

In August 2024, Gov. Greg Abbott signed an executive order directing hospitals to start collecting data “regarding patients who are not lawfully present in the United States” beginning Nov. 1, 2024, including the number of patients and the cost of care provided to those patients.

The Texas Health and Human Services Commission (HHSC) previously released the first set of data in March showing more than 30,000 undocumented people sought medical care in November.

An updated data release Wednesday shows that figure grew to 108,581 by the end of February, about 2.3% of all patients. More than 4 million patients said they were either a U.S. citizen or in the country lawfully, 84.8% of the statewide total.

Hospitals in Texas are required to ask each patient their immigration status, but patients are not required to answer. In the first four months of data collection, almost 617,000 patients 12.9% declined to answer the question.

The cost of care provided between November and February to patients reported as undocumented totaled more than $434 million, according to Affiliate KXAN’s analysis of HHSC data.

The number of patients who reported they were undocumented is not uniform across the state. Hospitals in Webb County, home to the city of Laredo in South Texas, had the highest share of undocumented patients. Almost 13% of patients in the county self-identified as not being in the country legally.

Hartley County, northwest of Amarillo, was the only other county to have more than 10% of patients who were undocumented. Among the 158 counties that had data, 25 reported no patients who were in the country unlawfully.

Of the 611 hospitals required to collect the data, only 471 were in compliance with the June 1 deadline for updated information, as outlined in Abbott’s order. The data shows 140 hospitals, 22.9%, were not in compliance. KXAN reached out to HHSC to ask what will be done regarding those hospitals and have not yet received a response.

Abbott previously said his executive order was in response to then-President Joe Biden and Vice President Kamala Harris’ “open border policies.”

“Now, Texas has reliable data on the dramatic financial impact that illegal immigration is having on our hospital system,” Andrew Mahaleris, Abbott’s press secretary, said after the initial data release in April. “Because of President Trump’s swift action in securing the southern border, illegal crossings have dropped to record lows. Texas is hopeful that his efforts to remove those who entered unlawfully may also cause these healthcare costs to decline.”

KXAN reached out to the governor’s office Wednesday for comment on the updated data release but have not yet received a response.

Hospitals are required to inform patients that responding to the question will not affect their care. Still, immigrant advocate groups are concerned about the executive order’s impact. The American Civil Liberties Union of Texas previously told KXAN it was worried the order would discourage undocumented Texans from seeking necessary medical care.

“This order should not impact anybody’s access to care period,” David Donatti, senior staff attorney with the ACLU of Texas, said. “Whether you are native-born, a U.S. citizen, an immigrant, whatever your status should be, you should be able to access the healthcare that you need, and the facility should not have the ability to block you from receiving that kind of care. That is crystal clear as a matter of federal law.”

The Texas Hospital Association had no comment Wednesday after the updated data was released, but previously told KXAN that hospitals have complied with the executive order by meeting deadlines and working with the state on clarifications along the way. 

“The fact that hospitals are required to collect this data should not be a deterrent for people in need of care. Hospitals remain open and ready to serve Texans’ acute care needs,” said Carrie Williams, chief communications officer with THA. “With 24/7 life-saving care, hospitals are required by law to treat anyone who comes through the door, regardless of ability to pay, regardless of their demographics.”

Texas has the highest uninsured rate in the nation at 17% more than double the national average. Five million Texans had no insurance as of 2022, THA reported. In 2023, hospitals provided more than $8.1 billion in “charity care” for uninsured people, with more than $3 billion not reimbursed.

Most uninsured Texans are citizens, however. While 1.6 million undocumented immigrants live in Texas, they go to the hospital at lower rates than U.S. citizens and make up a minority of the uninsured cost burden on state hospitals, the Texas Tribune reported.

Hospitals are required to report the data to HHSC each quarter. As part of the executive order, the data will be reported annually, beginning next year, to the governor, lieutenant governor and speaker of the House.