An executive order issued by Texas Gov. Greg Abbott in 2024 drastically changed the way immigrants living in the state treat their illnesses and approach doctor visits.
Since Nov. 1 of that year, hospitals in Texas that accept Medicaid or Children's Health Insurance Program coverage have asked all patients about their immigration status and whether they are lawfully present in the United States. In the 16 months since the executive order took effect, public health experts say many people have avoided hospitals altogether out of fear of immigration enforcement.
According to an investigation by The Texas Tribune, Texas hospitals have reported a significant decrease in visits from undocumented immigrants in the last 10 months. In November 2024, when hospitals began asking individuals about their immigration status, they reported about 30,000 visits from undocumented immigrants. By August 2025, that number dropped to 20,345, a decline of 32 percent.
"Substantial shares of immigrants are saying they have avoided seeking medical care due to immigration-related fears," Drishti Pillai, director of immigrant health policy at KFF, a health policy organization that regularly surveys immigrants about policies affecting their access to care, told The Texas Tribune.
When visiting a hospital, patients are asked about their citizenship status, a question they can decline to answer, although facilities track responses and submit them to Texas Health and Human Services. But for many individuals, going to the hospital is now out of the question because it could put them at significant risk.
That was the case for a 54-year-old woman who spoke to The Texas Tribune. She said she fell on a tile floor during a child's birthday party last October and begged her family not to take her to the hospital despite sharp pain running down her back.
Since her fall last year, she told the outlet that "not a day goes by that I don't experience some type of headache," adding that she had vision problems for a couple of weeks after the incident and still suffers from dizzy spells and some memory loss.
"It's not worth the risk," the woman told the outlet on the condition of anonymity for fear of deportation.
When Gov. Abbott introduced his executive order in 2024, he argued the change would provide a clearer picture of how much money Texas hospitals spend caring for undocumented immigrants. But as noted by The Texas Tribune, while hospital visits by undocumented immigrants have dropped significantly in the last 10 months, the average cost per visit has increased by about 50 percent, from $3,409 in November 2024 to $5,100 in August.
Health care policy experts and immigrant rights advocates say undocumented immigrants are also delaying preventive care such as cancer screenings, prenatal checkups and vision exams.
The decline in hospital visits among undocumented patients, according to the Tribune's analysis, has been reported across the state, but some of the steepest drops were at hospitals near the Mexico border.
Doctors Hospital of Laredo saw nearly a 48 percent decline in visits from undocumented patients, from 1,700 visits in November 2024 to 889 in August. South Texas Health System in Edinburg saw a 52 percent drop during the same period, from 1,127 to 538.
According to experts, many immigrants, even those with legal status in the United States, are postponing medical care over concerns about being mistakenly detained by immigration authorities.
As noted by The Texas Tribune, there have been cases in Texas in which people lawfully in the country have been detained by ICE. According to a recent KFF survey, about 1 in 7 immigrants avoided medical care out of fear of immigration enforcement.
"Regardless of immigration status, we are seeing substantial shares of immigrants say that the current policy environment and immigration-related concerns have led to negative health impacts for both immigrants and their children, the majority of whom are U.S. citizens," Pillai said.
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