Undocumented Immigrants Accrue Over $1 Billion in Texas Hospital Costs for FY 2025, Report Suggests Total May Be Higher

Texas hospitals have shouldered more than $1 billion in health care costs associated with undocumented immigrants during fiscal year 2025, according to newly released data from the Texas Health and Human Services Commission (HHSC).

This marks the first comprehensive accounting of such expenses since the state began tracking these figures under an executive order issued by Governor Greg Abbott in August 2024. The data, which was obtained by Texas Scorecard, reveals that hospitals documented 313,742 visits linked to individuals not legally present in the United States, with costs totaling $1.05 billion by the fiscal year’s end.

Texas’ fiscal year runs from September through August, but hospitals were only required to begin reporting in November 2024. With monthly costs averaging approximately $105 million, analysts suggest the true annual total could be significantly higher than reported. To put these figures in perspective, the hospital costs approach roughly 1% of the state’s tax-funded resources.

The largest portion of expenses came from inpatient discharges for patients without Medicaid or Children’s Health Insurance Program (CHIP) coverage, amounting to $565.4 million across 40,947 discharges. Emergency department visits for non-Medicaid and non-CHIP patients added another $205.5 million to the total.

Patients enrolled in Medicaid or CHIP also generated substantial costs, including $255.3 million for inpatient discharges and $24.3 million for emergency department visits.

Governor Abbott’s executive order mandated quarterly reporting by Texas hospitals on patients not lawfully present in the country. Hospitals must provide detailed breakdowns on the number of inpatient discharges, emergency department visits, and the associated costs of care.

“Texas, as a border state, has experienced some of the highest crossing numbers ever recorded under the Biden administration, putting immense pressure on its health care system,” said Andrew Mahaleris, Abbott’s press secretary, in a previous statement to Fox News Digital.

The reporting process began with November 2024 data, when hospitals documented 30,743 visits costing more than $102 million. Subsequent quarterly reports showed consistently high expenses: between December 2024 and February 2025, hospitals reported 149,619 visits totaling $330.8 million; from March through May 2025, costs reached $319.3 million; and from June through August 2025, expenses totaled $298.3 million.

The financial impact on Texas hospitals comes amid ongoing national debate about immigration policy and healthcare access. Many healthcare facilities are legally required to provide emergency care regardless of a patient’s immigration status or ability to pay, but they often bear the financial burden when patients cannot cover their medical expenses.

Rural and border-region hospitals are particularly affected by these uncompensated care costs, as they typically operate on thinner margins than larger urban medical centers. Industry experts note that these facilities often serve as safety nets for vulnerable populations, including both documented and undocumented residents.

The $1 billion figure represents a significant financial challenge for Texas’ healthcare infrastructure, potentially affecting hospitals’ ability to invest in new technologies, maintain staffing levels, or expand services. Some healthcare administrators have expressed concern that absorbing these costs could ultimately impact care quality for all patients if facilities must make operational adjustments to offset the expenses.

The data collection initiative is part of Texas’ broader efforts to document and address the impacts of immigration on state resources and services. Similar tracking measures have been implemented in other sectors, including education and law enforcement, as state officials seek to quantify the economic effects of migration patterns on public institutions.

As federal immigration policies continue to evolve, states like Texas are increasingly developing their own approaches to managing healthcare access and costs for undocumented populations, creating a complex patchwork of practices across the country.