An executive order in Texas now requires hospitals across the state to ask patients about their citizenship status.

The mandate set to take effect Nov. 1 is an effort to tally up how much money the state spends on medical care for undocumented immigrants and request that money back from the federal government. The hospital data must be reported to Texas Health and Human Services no later than March 1, 2025, and continue to be reported on a quarterly basis.

In a statement announcing the order, Texas Gov. Greg Abbott said, "Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants."

Kristen Etter, the director of policy and legal services for the Texas Immigration Law Council, says despite the order, hospitals are required to give emergency medical care to patients regardless of their immigration status. Also, patients are not required to answer the question.

"Do not let this deter you in any way from seeking the medical care that you or a loved one needs," Etter said. "Just in the same way you don't have to divulge other personal information — about maybe your sexual orientation or your religion — to obtain emergency medical care, it's similar that you do not have to divulge anything related to your immigration status, and declining to answer is complying with the order."

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A similar tracking effort in Florida hospitals released its first report this year. The state found undocumented immigrants made up 0.8% of hospital visits from June to December of 2023, accounting for less than 1% of total operating costs at $566 million.

Texas leads the nation in the number of uninsured residents, and according to the U.S. Census Bureau, most of those uninsured are U.S. citizens. Last year, Texas hospitals provided $3 billion in uninsured care. That is not reimbursed.

Etter says the tally in Florida and the one soon to come in Texas doesn't account for the contributions undocumented immigrants make into the economy.

"What gets lost in this entire discussion on providing medical care to immigrants is that it's just completely missing that huge piece, which is the economic contributions in the billions of dollars that they make to our state," Etter said.

Scripps News reached out to the governor's office requesting comment on the new mandate and critics' concerns around it but haven't heard back.