Texas hospitals reported more than $1 billion in healthcare costs connected to individuals “not lawfully present” in the United States during fiscal year 2025, the first year the state required facilities to track and report those figures.
Data compiled by the Texas Health and Human Services Commission (HHSC) and obtained by Texas Scorecard shows hospitals recorded 313,742 visits linked to patients not legally present, with total costs reaching $1.05 billion by the end of the fiscal year.
Texas’ fiscal year runs from Sept. 1 through Aug. 31, but hospitals were only required to begin submitting reports in November, meaning the total does not reflect a full 12 months of reporting. Based on the figures that were submitted, costs averaged roughly $105 million per month, suggesting the annual total could be higher once a full reporting year is captured.
Supporters of the reporting effort argue the totals represent a notable share of taxpayer-backed spending, pointing out that the reported hospital costs are approaching about 1% of the state’s tax-funded resources.
The data collection stems from an executive order signed by Gov. Greg Abbott in August 2024, directing the agency to track the number of “individuals not lawfully present” who use Texas public hospitals. Under the order, hospitals must provide HHSC quarterly breakdowns that include inpatient discharges, emergency department visits, and the estimated cost of care for those patients.
Texas, as a border state, recorded some of its highest crossing totals during the Biden administration, Abbott’s press secretary Andrew Mahaleris previously told Fox News Digital, describing the trend as a sustained strain on the state’s healthcare system.
The biggest portion of reported costs came from inpatient discharges for patients who were not enrolled in Medicaid or CHIP, totaling $565.4 million across 40,947 discharges, according to the report. CHIP, the Children’s Health Insurance Program, is a federal-state initiative that provides low-cost coverage for children in families who earn too much to qualify for Medicaid.
Hospitals also reported $205.5 million tied to emergency department visits for non-Medicaid and non-CHIP patients.
Patients enrolled in Medicaid or CHIP accounted for additional reported costs, including $255.3 million associated with inpatient discharges and $24.3 million linked to emergency department visits.
For FY2025, hospitals initially submitted data only for November 2024, reporting 30,743 visits costing more than $102 million, according to the state.
Later reports continued to show elevated spending. From December 2024 through February 2025, hospitals reported 149,619 visits totaling $330.8 million. Between March and May 2025, reported costs reached $319.3 million, followed by $298.3 million from June through August 2025.
