Florida and Texas — Recent measures in Florida and Texas mandate hospitals to request immigration status from patients, aiming to evaluate the cost of providing care to undocumented immigrants. In May 2023, Florida Governor Ron DeSantis signed Senate Bill 1718, requiring hospitals that receive Medicaid or Children’s Health Insurance Program (CHIP) funding to collect patient immigration status information. Similarly, in August 2024, Texas Governor Greg Abbott issued an executive order that mandates hospitals receiving Medicaid or CHIP funding to begin collecting this information starting November 1, 2024.
While these actions require hospitals to request immigration status, they must also inform patients that, in accordance with federal law, their response will not affect their care. In Florida, hospitals must explicitly state that the information provided will not be reported to immigration authorities. This specific assurance is not included in the Texas order. Federal law mandates that hospitals provide emergency screening and stabilization services to all patients, regardless of their immigration status.
Impact on Immigrant Families and Healthcare
Noncitizen immigrants, including those who are lawfully present and undocumented, constitute about one in ten residents in both Florida and Texas. As of 2022, Florida had around 2 million noncitizen immigrants, accounting for 9% of the state’s population, while Texas had approximately 2.8 million, making up 10% of its population. Many residents in both states live in immigrant families with mixed immigration statuses, including U.S.-born citizen children. In Florida, 17% of children have at least one noncitizen parent, while in Texas, the figure is 22%.
Research by KFF and others shows that despite higher uninsured rates, noncitizen immigrants, particularly undocumented ones, use less healthcare and have lower healthcare spending than U.S.-born citizens. Undocumented immigrants are less likely to report using healthcare services, including emergency care. Additionally, they have lower per capita healthcare expenditures and contribute more to the system through health insurance premiums and taxes than they use. This lower utilization of healthcare likely stems from a combination of being younger, healthier, and facing barriers to care, such as limited access to private insurance and Medicaid.
Undocumented immigrants are not eligible for Medicaid or other federally funded health coverage. Medicaid may pay for emergency services directly to hospitals for individuals who would otherwise qualify if not for their immigration status. Although federal funds cannot be used for Medicaid coverage for undocumented immigrants, some states use their own funds for this purpose.
Initial data from Florida indicate that less than 1% of hospital emergency room visits and admissions involved undocumented immigrants. Reports from June to December 2023 show that less than 1% of inpatient admissions and emergency department visits were from patients who identified as not lawfully present. An additional 7% to 8% of patients declined to provide their status, which may include undocumented immigrants. The state estimates that the cost of care for undocumented immigrants during this period was $556 million, though it’s unclear how much of that care was uncompensated. The legislative report noted that there was no clear correlation between the level of uncompensated care and the presence of undocumented immigrants, with higher levels of uncompensated care being more common in rural counties.
Broader Implications for Immigrant Communities and Economies
These new hospital requirements, along with other restrictive immigration policies, are likely to increase fear among immigrant families, potentially deterring them from seeking necessary healthcare. The Florida law also imposes penalties for hiring undocumented immigrants, expands employment verification, invalidates out-of-state driver’s licenses for undocumented individuals, and establishes criminal penalties for transporting undocumented immigrants into the state. Texas has passed legislation allowing law enforcement to question and arrest individuals suspected of being undocumented, though its implementation is delayed due to legal challenges.
These measures are expected to exacerbate fears within immigrant communities, leading to reduced healthcare access. A KFF analysis of restrictive immigration policies during the Trump administration found that such fears extend beyond undocumented immigrants to include lawfully present individuals and U.S.-born children in immigrant families. Reports suggest that Florida’s Emergency Medicaid expenditures decreased after the new requirements were implemented, possibly reflecting reduced healthcare use among undocumented immigrants, which could have negative health consequences.
The economic impact of these policies may also be significant. Limited healthcare access could reduce worker productivity, and increased fears may affect the workforce. Following the passage of SB 1718 in Florida, businesses in food service, agriculture, and construction reported losing employees and customers due to these fears. Similar effects are expected in Texas, where immigrants play a crucial role in the workforce. Noncitizen immigrants constitute 12% of the nonelderly adult workforce in both states, with even higher representation in specific sectors. In Florida, they account for 34% of construction workers, 47% of farming and fishing workers, and 17% of transportation workers. In Texas, they make up 41% of construction workers, 33% of farming and fishing workers, and 13% of transportation workers. The loss of workers in these occupations could have far-reaching consequences for the states’ economies.
These developments highlight the complex interplay between immigration policies, healthcare access, and economic stability in Florida and Texas. As these policies continue to unfold, their full impact on immigrant communities and state economies will become clearer.
