State data shows only 2% of hospital patients in Texas are in the country illegally

AUSTIN (KXAN) — State data shows only about 2% of patients at Texas hospitals are in the country illegally. In total, about 170,000 undocumented immigrants sought medical care in the state after hospitals were required to start asking every patient about their immigration status last November.

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 data showing the number of undocumented patients between November and February. In a new update, HHSC released data for March through May 2025. In those three months, a total of 61,628 undocumented patients were reported by hospitals, bringing the total since November to 171,211.

Of those, 157,107 patients were in hospitals considered ‘in compliance’ with the law as of May. Statewide, almost 400 hospitals had submitted the required form to the state showing patient data, which means about 36% of hospitals were not in compliance. The remaining patients were in hospitals that previously reported data, but did not in the most recent quarter.

The 157,000 undocumented patients made up only about 2.1% of all patients seen at those hospitals between November and May. About 85.8% of patients were either a citizen or in the country lawfully, while 12.1% of patients declined to answer the question.

HHSC reports hospitals spent more than $312 million on care for undocumented patients between March and May, bringing the total since November to more than $760 million.

The number of patients who reported they were undocumented is not uniform across the state. Hospitals in Tyler County, northeast of Houston, had the highest share of undocumented patients. Eight of the 19 patients seen at the Tyler County Hospital self-identified as not being in the country legally, about 42%.

Webb County, home to the city of Laredo, was the only other county to have more than 10% of patients who were undocumented, at 12.7%. Among the 142 counties that had data, 14 reported no patients who were in the country unlawfully.

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.”

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.