by Priscilla Totiyapungprasert

Posted November 21, 2024

 

Texas Gov. Greg Abbott’s executive order went into effect this month, requiring Texas hospitals to ask patients whether they are a U.S. citizen or lawfully present in the country.

 

The order, issued Aug. 8, demands that Texas hospitals enrolled in Medicaid and CHIP report the number of inpatient and emergency care visits by patients who are not authorized to be in the United States, as well as the cost of providing care to them.

 

Federal law requires that hospitals provide emergency care to all patients regardless of immigration status. Hospitals must notify patients their response will not affect their care, according to Texas Health and Human Services Commission guidelines.

 

Hospitals are also not required to ask patients for documentation to prove their status.

 

Patients have the legal right to withhold information about their citizenship and immigration. While hospitals have to ask, both citizens and non-citizens have no obligation to answer the question, said Imelda Maynard, legal director for Estrella del Paso, an organization that provides free immigration legal services to migrants and refugees in West Texas and New México.

 

“Every person in the United States has constitutional rights attached, regardless of status, and one of those is the right to remain silent,” Maynard said. “If a person is ever in doubt about what to say, the best thing to do is to not say anything at all.”

 

The vast majority of hospitals in Texas are enrolled in Medicaid, according to the Texas Hospital Association. Abbott’s directive applies to all the private and public hospitals in El Paso: The Hospitals of Providence, the Las Palmas and Del Sol Medical Centers, University Medical Center of El Paso and El Paso Children’s Hospital.

 

“The bottom line for patients is that this doesn’t change hospital care,” said Carrie Williams, a spokesperson for the Texas Hospital Association. “Texas hospitals continue to be a safe place for needed care. On the particulars of implementation, all hospitals are different. Hospitals across the state are working on the backend to determine how to comply with the reporting guidance and meet the state’s deadlines.”

 

The governor’s office did not respond to questions from El Paso Matters. Jennifer Ruffcorn, a spokesperson for the Texas Health and Human Services Commission, referred El Paso Matters to its website and declined to answer questions for clarification.

 

Why is Abbott forcing hospitals to ask for citizenship?

 

Human rights advocates in El Paso criticized Abbott for “using immigrants as scapegoats” and failing to mention how state law enforcement injures migrants.

 

Maynard described the executive order as a scare tactic.

 

“It’s meant to instill fear in people so they don’t seek out care they need,” Maynard said. “The whole purpose behind that is to intimidate people to stay home, not going to hospitals for fear they may have to disclose their status.”

 

In the executive order, Abbott claimed the federal government’s “open-border policies” have invited “mass illegal entry.”

 

The United States does not have an open border, however. The U.S. immigration system is made up of complex policies that determine who can enter the country, how they can enter, how long they can stay and what they can do, such as work and study.

 

“Any time anyone says it’s an open border, it’s not an accurate description,” Maynard said. “A truly open border would mean we don’t have ports of entry, CBP, Border Patrol, customs officers. We have long lines to get inspected. That’s not an open border.”

 

There was a 25% drop in migrant encounters on the border this fiscal year compared with last year, according to data from the U.S. Customs and Border Protection. In the El Paso sector, which spans southern New Mexico, El Paso and Hudspeth County, Border Patrol apprehended 40% fewer migrants who entered the country without authorization.

 

Abbott’s order is aimed at new arrivals, though the policy affects an estimated 52,000 people who live in El Paso County illegally. Many of those residents have lived in El Paso for years. They work in industries, such as construction and hospitality, and pay federal, state and local taxes, according to a report from the American Immigration Council.

 

Abbott further claimed undocumented patients impose a burden on the Texas health care system, and the federal government should be obligated to reimburse the state for costs. Abbott did not say how he would seek reimbursement.

 

Data suggests hospitals spend more on uninsured U.S. citizens than on immigrants, the Texas Tribune reported. Undocumented immigrants who lack access to health insurance plans typically use hospitals less than uninsured citizens.

 

How are El Paso hospitals complying with immigration questioning?

 

The state could remove hospitals that do not comply with the governor’s order from Medicaid and CHIP programs. El Paso Matters asked local hospitals how they’re handling the state directive.

 

Estefania Seyffert Morgan, a spokesperson for UMC, said registration staff asks patients about their immigration status after the patient has received stabilizing treatment. Registration staff gives patients the option to say they are unsure, unable to answer or refuse to answer.

 

“UMC cannot, and will not, be reporting the individual citizenship status to the state or federal immigration authorities on any patient,” Seyffert Morgan wrote in an email.

 

Seyffert Morgan said UMC is only questioning patients seeking inpatient care at UMC’s various facilities and visiting the emergency departments of UMC main campus on Alameda Avenue, the Northeast campus, the East campus and the surgical hospital on George Dieter Drive.

 

El Paso Children’s Hospital, a subsidiary of UMC, is also asking guardians for their child’s immigration status during registration, said Daniel Veale, spokesperson for the hospital. Information is presented in Spanish and English, and guardians can select from three options, one of which is “No information provided/Patient refused to answer.”

 

“Unfortunately, this is not information I am able to provide,” Hospitals of Providence spokesperson Monique Poessiger said in response to questions from El Paso Matters.

 

Las Palmas del Sol Healthcare referred El Paso Matters to the Texas Hospital Association, per Denise Bradley, vice president of marketing and corporate affairs for HCA Healthcare Central and West Texas Division.

 

Starting March 1, hospitals must report to HHSC each quarter the number of inpatient discharges and emergency visits of patients who are “(1) a citizen or an alien lawfully present in the United States, and (2) an alien not lawfully present in the United States.”

 

Asylum seekers are among the immigrants who are considered lawfully present. After they have been processed by border officials, asylum seekers are permitted to remain in the United States while their application is pending.

 

Hospitals must also report each quarter the aggregated costs of care for patients who are not lawfully present in the United States. On Jan. 1, 2026, HHSC will provide a report to the governor, lieutenant governor and speaker of the house on the preceding year’s costs.

 

HHSC has posted a spreadsheet template online for hospitals to input their data.

 

Several civil rights organizations in Texas have put together guidelines for hospital providers in an effort to mitigate both misinformation in the community and the risk of violating federal health laws, such as Emergency Medical Treatment and Labor Act. The guidelines include a script in how to communicate with patients.

 

“Hospitals should advise their patients that they are not required to provide an answer when asked about their immigration status, that any answers provided will not impact care, and that hospitals will not require any additional documentation to verify their status or answer,” the guidelines read.

 

 

Priscilla Totiyapungprasert is a health reporter at El Paso Matters and Report for America corp member. This article is republished from El Paso Matters under a Creative Commons license.