More than $1 billion spent on noncitizen hospital costs in fiscal 2025

By Bethany Blankley
The Center Square

Taxpayer-funded medical costs for noncitizens at Texas hospitals totaled more than $1 billion last year, according to newly released state data.

The data spans ten months in fiscal 2025, which goes from Oct. 1 through Sept. 30. The data only includes visits and costs from November 2024 through August 2025.

It was released in compliance with an August 2024 executive order issued by Gov. Greg Abbott directing the Texas Health and Human Services Commission to collect information on illegal foreign nationals who receive inpatient and emergency care at Texas public hospitals. It also requires HHSC to annually report all inpatient and emergency care costs incurred for illegal foreign nationals to the governor and state legislature in order for the state to seek reimbursement from the federal government, The Center Square reported.

The order states that current 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.” As a result, “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.” It also notes that Texans ultimately bear the costs in the form of higher taxes.

Abbott directed hospitals, including acute care hospitals enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) and any other providers HHSC identifies, to collect data on medical care provided to illegal foreign nationals statewide.

The data is broken down by number of visits and associated costs reported by hospitals’ emergency rooms and inpatient services that do or do not receive Medicaid and CHIP funds. It excludes non-hospital providers that provide medical care to illegal foreign nationals at taxpayers’ expense.

The categories include Emergency Department–Medicaid/CHIP; Emergency Department– NonMedicaid/Non-CHIP; Inpatient Discharges–Medicaid/CHIP; and Inpatient Discharges– NonMedicaid/Non-CHIP.

In the first category, there were 21,845 illegal foreign national visits to hospital emergency rooms reported, totaling $24,332,064 billed to taxpayers, according to the data.

In the second category, there were 230,480 illegal foreign national visits to emergency rooms reported that weren’t billed to Medicaid or CHIP, costing taxpayers $205,542,492.

In the third category, there were 20,470 illegal foreign national inpatient discharges billed to Medicaid/CHIP, totaling $255,352,904, according to the reported data.

In the fourth category, there were 40,947 illegal foreign national inpatient discharges reported not billed to Medicaid or CHIP, totaling $565,415,404.

Combined, total illegal foreign national visits were 313,742, costing taxpayers $1.05 billion, according to the data.

By quarter, the greatest number of visits were reported between December and February of last year, totaling 149,619 and costing more than $330 million, according to the data.

Abbott issued the hospital directive three years after Florida Gov. Ron DeSantis issued his, The Center Square reported. Texas’ reported costs are more than quadruple what was reported by Florida hospitals in previous years, The Center Square reported.

Abbott’s directive was also issued three years after he issued a disaster proclamation on May 31, 2021, which remains in effect. It states an historic surge of illegal border crossers during the Biden administration posed an “imminent threat of disaster for a number of Texas counties and for all state agencies affected by this disaster.”

Beginning April 21, 2021, and over the next few years, at least 55 counties declared an invasion and 60 counties issued disaster declarations citing the border crisis, The Center Square exclusively reported. These declarations also remain in effect.

At the height of the border crisis, Texas saw the most illegal border crossers in recorded history. In fiscal years 2022 and 2023, illegal entries in Texas totaled 1.4 million each year; gotaways, those who illegally enter to evade detection, totaled several hundred thousand each year, The Center Square exclusively reported. When combined, illegal entries in Texas totaled roughly two million each year at the height of the border crisis.

In fiscal 2023, Border Patrol agents reported nearly 450,000 known gotaways in Texas, The Center Square exclusively reported. That’s nearly double the number of illegal entries reported in Texas in fiscal 2025 – which saw an historic drop under the Trump administration, The Center Square reported.

Abbott maintains that the federal government should reimburse Texas for all of its costs associated with Biden administration “open border policies.” These are costs “which the state had no notice and which it could not have anticipated when agreeing to shared health funding mechanisms on the premise that the federal government would follow federal laws,” Abbott said.