Which specific U.S. states currently require hospitals to collect or report patients' immigration status and what do those statutes say?
Executive summary
Two states — Texas and Florida — currently require hospitals to collect patients’ immigration status and to report aggregated data on care provided to people not lawfully present, under an executive order in Texas and a state law in Florida [1] [2] [3]. Those mandates are limited in scope (targeting hospitals that accept Medicaid or are named in the Texas order), and both sets of measures include specific reporting timelines while leaving federal protections like EMTALA and HIPAA caveats in place [2] [4] [1].
1. Texas: Executive Order GA‑46 — what it requires and the reporting schedule
Governor Greg Abbott’s Executive Order GA‑46 directs the Texas Health and Human Services Commission (HHSC) to require covered hospitals to collect immigration-status information from patients and to report aggregate counts and costs for inpatient discharges and emergency visits by people “not lawfully present in the United States,” with hospitals to begin collecting information by November 1, 2024 and to submit quarterly data to HHSC with initial submissions due March 1, 2025, and an annual statewide report to state leaders beginning January 1, 2026 [2] [4] [5]. The order instructs hospitals to inform patients that federal law forbids denying care based on immigration answers and states the stated goal is to quantify state costs and seek federal reimbursement [2] [6].
2. Florida: Senate Bill 1718 — a statutory requirement tied to Medicaid participation
Florida’s Senate Bill 1718, enacted in 2023, requires hospitals that accept Medicaid funding to collect immigration-status information from patients as part of intake and reporting procedures; the law has been reported as creating a statewide collection mandate for hospitals that receive state Medicaid dollars [3] [7]. Reporting under Florida’s statute has been framed by state officials as a tool to measure public costs associated with care for people lacking legal status, although implementation details and exact reporting cadence have been reported in news coverage and state summaries rather than consolidated in a single source here [3] [7].
3. Federal protections, limits and how advocates interpret them
Federal statutes and guidance remain relevant: EMTALA requires hospitals to provide emergency stabilizing treatment regardless of ability to pay or immigration status, a protection stressed by legal and health advocates [4] [8], while HIPAA generally prohibits disclosure of protected health information absent patient authorization though it contains limited law‑enforcement exceptions — a point legal groups highlight to caution against routine sharing with immigration authorities [1] [9]. The National Immigration Law Center and state attorneys general guidance note that these state mandates do not create an affirmative federal duty for providers to report status to immigration enforcement, and HIPAA does not compel release to immigration authorities under ordinary circumstances [1] [9].
4. Public health, ethical and operational concerns raised by hospitals and advocates
Medical organizations and public‑health commentators warn that mandating status collection can chill care-seeking among immigrant communities, reducing trust in hospitals and deterring necessary care, especially for children and emergency needs — an effect documented in surveys and raised repeatedly by advocacy groups and medical schools [6] [10] [11]. Hospitals themselves have said they will not turn away patients and emphasize EMTALA obligations, but administrators and clinicians report anxiety over added administrative burdens and potential erosion of patient trust [10] [12].
5. Political framing and competing narratives
State officials in Texas and Florida frame these requirements as fiscal accountability measures intended to quantify uncompensated care and reclaim federal dollars, a narrative reflected in official statements and state press releases [2] [13]. Opponents frame the measures as politically motivated policies that risk public health harms and may produce unreliable or incomplete data because patients can decline to answer and hospitals report aggregate rather than individually identifiable data [6] [7].
6. Limits of available reporting and what remains unclear
Existing public reporting and guidance establish that Texas and Florida have active mandates, but sources vary on granular implementation details — for example, the precise format of data collection tools, enforcement mechanisms if patients decline to answer, and the extent to which hospitals will share data with immigration authorities — and those specifics are not fully documented in the provided reporting [2] [3] [6]. The National Immigration Law Center and state guidance confirm two states have mandates but also caution that federal HIPAA and EMTALA protections remain relevant; beyond Texas and Florida, available sources here do not document other states with comparable statutory requirements [1] [9].