Texas Hospitals Spent 121M on Healthcare for Immigrants Without Legal Status

A new Texas state report claiming that undocumented immigrants cost hospitals $121.8 million in November 2024 is under scrutiny by health policy experts, who say the figure lacks necessary context about broader health care costs.

The Texas Health and Human Services Commission released the data Friday following a directive by Gov. Greg Abbott requiring hospitals to ask patients about their citizenship status. Abbott said the move would highlight the financial burden undocumented immigrants place on the healthcare system and pressure the federal government for reimbursement.

“Now, Texas has reliable data on the dramatic financial impact that illegal immigration is having on our hospital system,” Abbott’s press secretary said Friday.

However, policy analysts say the report does not compare costs from undocumented immigrants to the far greater expenses hospitals face from uninsured U.S. citizens. “$121.8 million is a fraction compared to the overall costs from uninsured Texans,” said Lynn Cowles, health and food justice programs manager at Every Texan, a left-leaning think tank.

Texas has the highest uninsured rate in the country, with about 4.8 million residents — or 19% of the population under age 65 — lacking health insurance, according to the U.S. Census Bureau.

The report also does not specify how much of the reported costs hospitals might later recover through programs like emergency Medicaid, which provides limited reimbursement for emergency services regardless of immigration status.

Critics warn that focusing narrowly on undocumented immigrants could create a misleading narrative about the true challenges facing Texas hospitals. "The real issue is the state's massive uninsured population," Cowles said.

Texas is home to roughly 1.7 million undocumented immigrants, according to estimates.

A full annual report on the hospital costs associated with immigration status is expected to be released by the Texas Health and Human Services Commission in January 2026.