Texas hospitals are now required to ask for patients’ citizenship. Here’s what you should know.

The emergency drop-off at an Austin hospital on March 30, 2020. (Credit: Miguel Gutierrez Jr./The Texas Tribune)

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On Nov. 1, Texas hospitals that accept Medicaid or Children’s Health Insurance Plan coverage started asking all patients about their immigration status and whether they are lawfully present in the United States. The requirement is part of an executive order Gov. Greg Abbott issued this summer.

The information is statistical only. No identifying information about the patient is passed along to the governor’s office.

Here’s what you need to know.

Do I have to answer hospitals’ questions about my citizenship or immigration status?

No. According to several advocacy groups, including the American Civil Liberties Union, while hospitals are required to ask patients about their citizenship or immigration status, they cannot force anyone to answer the question. Patients can either answer the question or tell the hospital that they don’t wish to respond.

Will I be denied treatment if I refuse to answer?

You should not be denied health care treatment for refusing to answer questions about your citizenship or immigration status. Abbott’s order says hospitals should inform patients that their response to this question will not affect their care as required by federal law.

Harris Health in Houston, which includes Ben Taub and LBJ hospitals, said in a statement: “Regardless of how they answer the citizenship status question, it will in no way interfere with their receiving healthcare at Harris Health emergency rooms or hospitals.”

What if a hospital employee pressures me to respond? What recourse do I have?

A patient can ask to speak to the supervising nurse on duty, the hospital’s guest relations staff or a patient rights advocate. If a patient believes the hospital’s staff behaved improperly when asking for their citizenship or immigration status, they can contact the ACLU through this intake form.

Why are hospitals doing this?

Hospitals are required to do this because of the governor’s order. Abbott is requiring them to do this because he wants a clearer picture of how much money Texas hospitals spend caring for undocumented immigrants. Abbott has argued that the Biden administration’s immigration policies have cost states more money and that the federal government should reimburse states for those costs

What will hospitals do with this information?

Abbott’s order requires hospitals to count how many times they have asked the question of patients and keep track of the patient answers they receive. They are not sharing personal information about a patient to any state agency.

At what point of the visit are they asking this question?

Hospital staff can ask about their citizenship or immigration status at any point during the intake process but asking the question cannot impact patient care.

Does the governor’s order apply to the urgent care clinics that are run by hospitals?

It only applies to hospitals, not their clinics, according to the Texas Hospital Association. The Texas Tribune has not received any reports of urgent care clinics asking patients about their citizenship or immigration status.

Are all patients being asked this question?

Yes.

Will I be asked this question regardless of my ability to pay for care?

Yes.

What if I don’t feel comfortable asking for more information or discussing my rights in English?

According to the ACLU, if you have concerns about your rights or care but don’t feel comfortable discussing them in English, you should request an interpreter fluent in your native language.

Disclosure: Texas Hospital Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.