Logan Reid
In the United States, hospitals and healthcare providers are generally not required to report illegal immigrants. The Health Insurance Portability and Accountability Act (HIPAA) privacy law prohibits the use or disclosure of personal health information without a patient's consent, except when required by law. However, as of November 1, 2024, a Texas executive order (GA-46) mandates hospitals to collect information about patients' immigration status and report this data, along with the costs of care provided to undocumented patients, to the Health and Human Services Commission (HHSC) quarterly. Despite this order, patients are not required to provide information about their immigration status, and their access to emergency medical care is still protected by federal law, regardless of their ability to pay or immigration status.
| Characteristics | Values |
|---|---|
| Hospitals reporting illegal immigrants | In the US, health care providers have no legal obligation to report a patient's immigration status. However, two states require hospitals to ask patients about their immigration status and report the aggregate amount of uncompensated care provided to undocumented patients. |
| Texas Executive Order | Effective November 1, 2024, Texas hospitals are required to collect information about patients' immigration status and report this data, along with the costs of care provided to undocumented patients, to the Health and Human Services Commission (HHSC) quarterly. |
| Patients' rights | Patients are not required to disclose their immigration status and cannot be denied medical care if they refuse to do so. Federal law, such as EMTALA, mandates that hospitals provide emergency medical treatment to anyone in need, regardless of immigration status. |
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What You'll Learn
In Texas, hospitals must ask about immigration status
Texas hospitals are now required to ask patients about their immigration status. This mandate came into effect on November 1, 2024, following an executive order (GA-46) by Republican Governor Greg Abbott. The order expands the state's clash with the Biden administration over immigration.
The executive order requires hospitals to collect information about patients' immigration status and report this data, along with the costs of care provided to undocumented patients, to the Health and Human Services Commission (HHSC) quarterly. Beginning January 1, 2026, HHSC must also provide annual reports to state leaders detailing the costs of inpatient and emergency care for patients who are "not lawfully present in the United States."
Governor Abbott justified the order by stating that ""Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants." He claimed that the order is intended to allow the state to review the costs connected with providing medical services to undocumented immigrants. However, critics argue that this could scare people away from hospitals, as it has already done in Florida, which enacted a similar law in 2023.
While hospitals must ask about immigration status, patients are not required to answer. Health care advocates emphasize that everyone in Texas has a legal right to access emergency medical care, regardless of their immigration status, and they are encouraging all members of the community to decline to answer questions about their immigration status when seeking medical care.
The impact of this executive order on Texas children and families is a significant concern. CDF-Texas (Children's Defense Fund-Texas) believes that everyone deserves access to life-saving medical care, regardless of their immigration status, and that providing preventative care to all is in the best interest of all Texans. They worry that the order will create fear and confusion in immigrant communities, eroding patient trust in the healthcare system and discouraging families from seeking needed medical care.
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Patients don't have to answer
In the United States, the threat of immigration enforcement raises concerns among immigrant families, who may forego necessary medical services out of fear of repercussions. While hospitals are required to report medical care provided to undocumented patients, patients are not mandated to disclose their immigration status.
Executive Order GA-46, effective November 1, 2024, in Texas, mandates hospitals to inquire about patients' immigration status. However, the order explicitly states that patients are not required to provide this information and can decline to answer without legal, financial, or healthcare consequences. This is affirmed by the Texas Medical Association, which emphasizes that medical care cannot be interrupted or denied due to non-disclosure of immigration status.
Federal law, such as the Health Insurance Portability and Accountability Act (HIPAA) and the Federal Emergency Medical Treatment and Labor Act (EMTALA), protects patients' rights to privacy and emergency medical care, regardless of immigration status. These laws generally prohibit the use or disclosure of personal health information without consent and require hospitals to provide emergency care to anyone in need.
It is important to note that patients have the right to have a lawyer present during interviews with law enforcement and to decline to answer questions unless authorized by a designated staff member. Patients should also be reminded that they have the right not to answer any questions from immigration officers, although they may need to provide their name in certain jurisdictions.
By upholding these rights and refusing to provide information about immigration status, Texans can collectively protect their community's right to access emergency medical treatment.
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Medical care cannot be denied for non-disclosure
In the United States, undocumented immigrants are at high risk of being uninsured and face barriers to accessing healthcare due to their high uninsured rates. They are not eligible for Medicare, Medicaid, or CHIP and cannot purchase coverage through the ACA Marketplaces.
Despite this, medical care cannot be denied to undocumented immigrants based on non-disclosure of immigration status. The Health Insurance Portability and Accountability Act (HIPAA) privacy law prohibits the use or disclosure of personal health information without a patient's consent, except when required by law. While there are some exceptions, such as allowing information to be shared with law enforcement officials for law enforcement purposes, the release of information is generally not required.
Furthermore, under the Emergency Medical Treatment and Labor Act (EMTALA), any person, citizen or not, who presents to a hospital with an "emergency medical condition" is entitled to receive whatever stabilizing care the hospital can reasonably provide. Hospitals are required to screen and stabilize every patient who seeks emergency care, regardless of their immigration status. If a hospital is unable to provide appropriate treatment, it must arrange a transfer to a facility with the necessary capacity.
In addition, the Fourth Amendment to the U.S. Constitution protects individuals from unreasonable search and seizure, which includes immigration enforcement actions. This means that patients may be more vulnerable to immigration enforcement when they are in areas of a hospital that are open to the public, as they have a reduced expectation of privacy in these areas.
While there are some states that require hospitals to ask patients about their immigration status, healthcare providers are not legally obligated to inquire about or report a patient's immigration status to federal authorities. Hospitals must also restrict access to patient areas to essential medical personnel and avoid collecting immigration status information to protect patient privacy.
Overall, while there may be challenges in accessing healthcare for undocumented immigrants, medical care cannot be denied based on non-disclosure of immigration status, and healthcare providers are not required to report this information to authorities.
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Hospitals must report uncompensated care
The American Hospital Association (AHA) publishes aggregate information on the level of uncompensated care delivered by all types of U.S. hospitals. This information is sourced from the AHA's Annual Survey of Hospitals, which is the nation's most comprehensive source of hospital financial data. The AHA combines the hospital's bad debt and financial assistance costs to arrive at the total costs of uncompensated care provided to patients.
Medicare defines uncompensated care as the total amount of charity care and bad debt. Since April 2003, Medicare has required acute care hospitals to provide detailed uncompensated care information in Worksheet S-10. This worksheet requires hospitals to submit cost reports containing data on the costs incurred for providing inpatient and outpatient hospital services for which the hospital is not compensated.
Uncompensated care excludes other unfunded costs of care, such as underpayment from Medicaid and Medicare. Hospitals provide varying levels of financial assistance, which must be budgeted for and financed based on factors such as the hospital's mission, financial condition, and geographic location. Uncompensated care costs can be calculated by multiplying the sum of bad debt and financial assistance charges by the hospital's cost-to-charge ratio.
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HIPAA generally prohibits disclosure of personal health info
In the United States, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 establishes national standards to protect individuals' medical records and other individually identifiable health information. This includes protecting sensitive health information from disclosure without a patient's consent. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement the requirements of HIPAA.
The Privacy Rule standards address the use and disclosure of individuals' protected health information (PHI) by entities subject to the rule. These entities, known as "'covered entities," include health plans, health care clearinghouses, and health care providers that conduct certain health care transactions electronically. The Privacy Rule also contains standards for individuals' rights to understand and control how their health information is used. It protects individual health information while allowing necessary access to promote high-quality healthcare and protect the public's health.
Covered entities must develop and implement policies and procedures that restrict access to protected health information based on specific workforce roles. They must identify which members of their workforce need access to protected health information to carry out their duties. The Privacy Rule permits covered entities to use and disclose protected health information for research purposes without an individual's authorization under certain conditions. For example, if an alteration or waiver of authorization has been approved by an Institutional Review Board or Privacy Board, or if the researcher provides representations that the use or disclosure is solely to prepare a research protocol or for a similar preparatory purpose.
There are exceptions to the minimum necessary requirement for disclosure, including disclosure to a healthcare provider for treatment, disclosure to the individual who is the subject of the information or their personal representative, and use or disclosure required by law or for compliance with other HIPAA rules. The HIPAA Security Rule protects a subset of information covered by the Privacy Rule, specifically all individually identifiable health information that a covered entity creates, receives, maintains, or transmits in electronic form, known as electronic protected health information (e-PHI). The Security Rule does not apply to PHI transmitted orally or in writing.
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Frequently asked questions
In the US, health care providers have no legal obligation to report a patient's immigration status to federal immigration authorities. However, as of November 1, 2024, Texas hospitals are required to collect information about patients' immigration status and report this data to the Health and Human Services Commission (HHSC) quarterly.
No, hospitals cannot deny treatment to illegal immigrants. The Federal Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to provide care in emergencies to anyone in need, regardless of immigration status.
You are not required by law to disclose your immigration status to hospital staff. Refusing to respond is not a crime, and your medical care cannot be interrupted as a result of non-disclosure.
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