Texas hospitals accumulated more than $1 billion in health care costs for patients not lawfully present in the United States during fiscal year 2025. This was the first year Texas formally tracked these expenses. The data was compiled by the Texas Health and Human Services Commission and obtained by Texas Scorecard.
According to the report, hospitals recorded 313,742 visits linked to individuals not legally present in the country, with total reported costs reaching $1.05 billion by the end of the fiscal year.
Why the True Cost Is Likely Higher
Texas’ fiscal year runs from September 1 through August 31. However, hospitals were not required to begin reporting immigration related data until November 2024. Based on the available data, costs averaged roughly $105 million per month. That suggests the true annual total may be significantly higher once the unreported early months are considered.
State officials have also noted that hospital submissions are still subject to updates and revisions, meaning the final total could increase further.
Governor Abbott’s Executive Order
The reporting requirement stems from an executive order signed in August 2024 by Greg Abbott. The order mandated that Texas public hospitals track and report the use of services by individuals not lawfully present in the United States.
Under the directive, hospitals must submit quarterly breakdowns detailing inpatient discharges, emergency department visits, and the cost of care provided. Hospitals are also required to inform patients that answering questions about immigration status will not affect their access to treatment, as required by federal law.
Abbott’s office has said the data highlights the pressure placed on Texas’ health care system as a border state experiencing some of the highest migrant crossing numbers ever recorded.
How the Costs Break Down
The largest share of expenses came from inpatient care for patients who were not enrolled in Medicaid or the Children’s Health Insurance Program. Those inpatient discharges totaled $565.4 million across 40,947 cases.
Emergency department visits for non-Medicaid and non-CHIP patients added another $205.5 million in costs.
Patients enrolled in Medicaid or CHIP also accounted for substantial expenses. Inpatient discharges for those patients totaled $255.3 million, while emergency department visits added $24.3 million.
Overall, inpatient care exceeded $820 million, showing that long-term hospitalizations, not just emergency treatment, were a major driver of the total cost.
The first required reporting month, November 2024, recorded 30,743 visits costing more than $102 million.
From December 2024 through February 2025, hospitals reported 149,619 visits totaling $330.8 million.
Between March and May 2025, reported costs reached $319.3 million. From June through August 2025, hospitals reported an additional $298.3 million in costs.
To put the figures in perspective, the reported hospital costs approach about 1 percent of Texas’ tax funded resources. While hospitals are required by federal law to provide care, unpaid medical costs are ultimately passed on to Texans through higher insurance premiums, increased public hospital funding, and state health programs.
How This Compares to Earlier Estimates
In 2021, Texas Attorney General Ken Paxton estimated that uncompensated care for illegal immigrants cost Texans between $579 million and $717 million per year. The partial fiscal year 2025 total alone already exceeds that range, even before accounting for the months that were not reported.
Supporters of the reporting requirement argue the data confirms long-standing concerns about the financial strain illegal immigration places on state health systems. They say the figures strengthen the case for tighter border enforcement and greater federal accountability.
Critics argue that hospitals have no choice but to provide care and warn that focusing on immigration status risks politicizing health care. They also point out that emergency treatment is required by law and that hospitals would face ethical and legal issues if care were denied.
With reporting now in place, Texas officials say future years will provide a clearer picture of the full cost. For now, the first year of data has intensified debate over immigration policy, federal responsibility, and who ultimately pays when hospital bills go unpaid.
IAM Editor: First, the fact that reporting requirements are controversial shows how adamant liberals are about hiding the truth.
Second, this is a billion dollars in just one state.
