Texas hospitals reported more than $1 billion in care costs tied to patients who are not legally present in the United States during fiscal year 2025, according to state health agency data collected after an executive order required tracking. The figures cover hundreds of thousands of visits and expose a growing strain on hospitals that lawmakers and taxpayers are watching closely.
The state Health and Human Services Commission logged 313,742 visits linked to people not legally present, with total billed costs reaching roughly $1.05 billion for the fiscal period. Reporting began in November of the fiscal year, so the full picture may be larger than the numbers released so far. These raw totals make clear the scale of the issue hospitals have been shouldering.
Gov. Abbott’s directive set the rules for this new reporting requirement and asked hospitals to identify “individuals not lawfully present” who receive care. The order required quarterly breakdowns that include inpatient discharges, emergency department visits and the cost of care for those patients. That push for data was meant to give officials a clear accounting of the burden on public health resources.
When spread across months, the numbers average out to roughly $105 million a month in hospital costs tied to these patients, a rate that suggests the annualized total could be greater than what was initially logged. Those costs are significant enough to equal about 1 percent of Texas’ tax-funded resources, a nontrivial impact on state budgeting. For a state that balances rapid population growth with stretched systems, this is a fiscal red flag.
The biggest chunk of expense came from inpatient stays for patients who were not covered by Medicaid or CHIP, totaling $565.4 million across 40,947 discharges. Emergency department visits for those same non-Medicaid, non-CHIP patients added another $205.5 million. Those categories are costly because inpatient care and emergency services are expensive by nature and often require uncompensated or undercompensated treatment.
Costs tied to patients enrolled in Medicaid or CHIP were also substantial, with inpatient expenses of $255.3 million and emergency visits accounting for $24.3 million. That shows taxpayer-funded programs absorbed a notable portion of the total, even as uncompensated care by private or public hospitals drove the larger share. These figures complicate the argument that federal or state health programs are not affected by migration flows.
Initial monthly snapshots show the pace of care demand. Hospitals reported 30,743 visits in November alone, costing more than $102 million. Between December and February the tally climbed to 149,619 visits with $330.8 million in costs, illustrating how quickly the fiscal load can accumulate when arrivals and care needs surge.
Reporting continued with $319.3 million logged from March through May, and another $298.3 million from June to August, keeping totals elevated across the fiscal cycle. Border crossings and migration patterns have been cited by state officials as major contributors to the pressure on emergency departments and inpatient services. The result is a healthcare system stretched thin in communities that must absorb the immediate costs.
This is not just a hospital problem, it is a public finance problem and a policy problem. State leaders are left asking how to protect hospitals, keep care available for Texans, and make sure the federal government does its part. Without stronger border control and a clearer federal funding plan, the fiscal and operational strain on Texas hospitals will only grow.
Graduate Student, wife, engaged political and legal writer.