Know Your Rights in Texas Hospitals: Decline to Answer Immigration Status Questions

On August 8, 2024, Governor Greg Abbott issued executive order GA-46. This executive order requires the Texas Health and Human Services Commission (“HHSC”) to require all “acute care hospitals enrolled in Medicaid or the Children’s Health Insurance Program, and any additional hospitals identified” in Texas to collect information from patients who are undocumented — including immigration status.

Hospitals impacted by this order will also be required to collect and report on the healthcare costs of undocumented patients as well as the number of patient discharges and emergency visits.

This executive order is in effect as of November 1, 2024.

• Federal privacy law prohibits the disclosure of protected health information without authorization from the patient.
• Answers about immigration status that are provided to hospitals should not impact applications for legal permanent residency.
• The Emergency Medical Treatment and Labor Act (EMTALA) ensures access to emergency care regardless of ability to pay. This means hospitals are still required to provide emergency care or stabilization to patients experiencing an emergency.

• It directs hospitals to inform patients that any answers to questions about immigration status will not affect patient care.
• It requires hospitals to report data on patient immigration status, including the number of inpatient discharges and emergency visits by patients, and the cost of the care provided to patients. This reporting requirement starts March 1, 2025.
• It requires hospitals to begin annual reporting in 2026 on such data to the governor, lieutenant governor, and the speaker of the House on the annual cost for inpatient and emergency care of patients not lawfully present in the United States.

• It does not require that patients answer the question about their immigration status. The order only directs hospitals to ask, collect, and report the information to the outlined agencies and officials.
• It does not require hospitals to report individual immigration status with identifying information.
• While HHSC guidance states that providers must ask immigration status at intake, this was not specified in the order.