By Hannah Davis
FAIR
Texas Governor Greg Abbott recently signed an executive order requiring the Texas Health and Human Services Commission (HHSC) to track, collect, and report medical costs incurred for treating illegal aliens in the Lonestar State. Governor Abbott wants to use the data that will be collected from this executive order to bill the federal government.
Governor Abbott contends this executive order is necessary because of the Biden-Harris administration’s immigration policies that have “invited mass illegal entry” into Texas. Because the state could not have anticipated the costs from the administration’s abdication of its responsibilities to secure the border in violation of federal law, Governor Abbott asserts that the federal government “should be obligated to reimburse the State of Texas for the costs that its open-border policies have imposed on Texans.”
“Federal law contributes to the growth of uncompensated medical costs by requiring that any individual must be allowed to obtain emergency medical treatment regardless of that individual’s immigration status, or willingness or ability to pay for such treatment; and the State of Texas absorbs a large percentage of the costs associated with medical care for individuals who are not lawfully present in the United States,” said Governor Abbott.
Medicaid, which only pays the emergency health care costs for illegal aliens below a certain income level, is jointly run by the federal government and the states. States submit a Quarterly Medicaid Statement of Expenditures to claim Federal reimbursement for each quarter. Under the laws governing Medicaid, the federal government reimburses states a certain percentage of the total expenditures, which is calculated on multiple criteria designed to determine the share fairly attributable to the state versus the federal government.
In order to seek reimbursement from the federal government, the Governor’s Executive Order GA-46 requires the HHSC to:
- Direct hospitals and additional identified providers to collect information on the costs of medical care provided to illegal aliens beginning November 1, 2024.
- Direct covered hospitals to report the data it collects to the HHSC quarterly with the initial submission due March 1, 2025.
- Report annually, beginning on January 1, 2026, to the Governor, the Lieutenant Governor, and the Speaker of the House on the preceding year’s costs, as conveyed by the hospitals, for inpatient and emergency care for illegal aliens.
Gabriel Rosales, Texas state director for the League of United Latin American Citizens (LULAC), claims the executive order is “ludicrous.” She says that it will “immediately intimidate the community, our immigrant community, from trying to get the help that they need.”
However, because federal law already ensures that the public has access to emergency medical services, it is clear that the executive order is not designed to keep illegal aliens from getting treatment. Rather, it’s to ensure that the federal government, not taxpayers in Texas, are footing the bill for such services. Moreover, Governor Abbott’s executive order explicitly directs hospitals — while collecting the information from its patients — to inform them that their responses will not affect patient care.
The purpose of the executive order is merely to determine the exact financial impact of today’s open-border policies on Texas.
According to research by FAIR, illegal aliens cost Texans a staggering $13.4 billion in 2023, which includes their medical expenditures and welfare.
Texas is not alone in its efforts to determine the medical costs associated with illegal immigration. Florida began tracking these costs last year, leading to a 54 percent decrease in expenditures billed to the state’s Medicaid program — from $148.4 million to $67 million — thereby reducing the burden on taxpayers.
Texas’ executive order marks a significant step in the state’s ongoing efforts to manage the financial impact of illegal immigration on its healthcare system. As the state prepares to implement these measures, the broader national conversation on immigration and its economic effects is likely to intensify, with Texas leading the charge for greater accountability from the federal government. In the words of Governor Abbott, “Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants.”
