HHSC data obtained by Texas Scorecard show Texas hospitals reported $1.05 billion in costs tied to patients described as not lawfully present during fiscal year 2025, covering 313,742 visits. The largest share — $565.4 million — came from inpatient discharges for patients not enrolled in Medicaid or CHIP. Reporting began in November 2024, so monthly averages indicate the full-year total could be substantially higher.
Texas Hospitals Logged $1.05B In FY2025 Care For Patients Not Lawfully Present — True Cost Likely Higher
Medical staff transport a patient through a hospital corridor in Texas.(Getty Images)
Texas hospitals recorded more than $1.05 billion in healthcare costs tied to patients described by state officials as "individuals not lawfully present" during the 2025 fiscal year, according to data compiled by the Texas Health and Human Services Commission (HHSC) and obtained by Texas Scorecard.
Key Findings
Total Reported Costs and Visits: HHSC data show hospitals logged 313,742 visits linked to patients not lawfully present, with cumulative costs of $1.05 billion for the reported period.
Texas Gov. Greg Abbott arrives for an event in Austin, Texas, Sept. 23, 2025. Abbott signed an executive order in 2024 mandating the Texas Health and Human Services Commission track the number of "individuals not lawfully present" in the U.S. who use Texas public hospitals.
Breakdown by Care Type: The largest share of reported spending came from inpatient discharges for patients who were not enrolled in Medicaid or CHIP: $565.4 million across 40,947 discharges. Emergency department visits for non-Medicaid and non-CHIP patients added $205.5 million.
Patients enrolled in Medicaid or CHIP also accounted for substantial spending: $255.3 million in inpatient costs and $24.3 million for emergency department visits.
Immigrants wait to be processed at a U.S. Border Patrol transit center after they crossed the border from Mexico on Dec. 20, 2023, in Eagle Pass, Texas.
Reporting Window And Why The Total May Be Higher
Texas’ fiscal year runs from September 1 through August 31, but mandatory reporting under Governor Greg Abbott's August 2024 executive order began in November 2024. Because hospitals were required to start submitting data only in November, the monthly average from the reported months—about $105 million per month—suggests the full-year total could be materially larger than the $1.05 billion figure.
Monthly Reporting Highlights
- November 2024: 30,743 visits costing more than $102 million.
- December 2024–February 2025: 149,619 visits totaling $330.8 million.
- March–May 2025: Reported costs of $319.3 million.
- June–August 2025: Reported costs of $298.3 million.
Context And Sources
The data were gathered under an executive order directing HHSC to track quarterly totals for inpatient discharges, emergency department visits, and costs for individuals not lawfully present who use Texas public hospitals. Texas has experienced high border crossings in recent years, placing additional pressure on public services, a dynamic noted by administration officials.
Source: Texas Health and Human Services Commission data obtained by Texas Scorecard; public statements from state officials.
Note: All figures reflect reported hospital charges compiled by HHSC for the periods required under the executive order. Analysts and officials say the $1.05 billion total likely understates the full fiscal year burden because reporting began partway through the fiscal year.
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