Children’s Defense Fund-Texas (CDF-TX) is deeply concerned about the impact of Executive Order GA-46 on Texas children and families. Effective November 1, the order, announced by Governor Abbott on August 8, 2024, mandates that the Health and Human Services Commission (HHSC) direct Texas hospitals to collect information about patients’ immigration status and report this aggregate data, along with the costs of care provided to undocumented patients to HHSC quarterly. Beginning January 1, 2026, HHSC must also provide annual reports to state leaders detailing the costs of inpatient and emergency care for patients who are “not lawfully present in the United States.”
According to the Texas Immigration Law Council, the facilities subject to this order are “public hospitals and acute care facilities that accept Medicaid and/or CHIP funding.” Texas is home to more than 1 million U.S. citizen children who live with at least one undocumented family member. In today’s climate of anti-immigrant rhetoric and fears about mass deportations, requiring hospital staff to inquire about immigration status before providing care is likely to intimidate immigrant parents, deterring them from seeking medical care for themselves or their children—potentially endangering the health and lives of countless Texas families.
CDF-Texas joins our partners at Every Texan in urging the governor’s office to rescind Executive Order GA-46.
Know your rights: Under Executive Order GA-46, everyone in Texas is still entitled to access emergency medical care, regardless of immigration status.
The order acknowledges that federal law mandates emergency care for all and instructs hospital staff to inform patients that their immigration status will not impact care.
However, the real danger of the order is the likelihood that it will create fear and confusion in immigrant communities, eroding patient trust in the healthcare system and discouraging families—especially undocumented individuals—from seeking needed medical care.
Support your community: We are calling on all Texans to decline to answer when asked for information about their immigration status while seeking medical care.
It is important to note that while Executive Order GA-46 requires hospital staff to ask about patients’ immigration status, the order does not require patients to provide that information when asked, and it does not set out any legal, financial, or healthcare consequences for declining to answer questions about immigration status or lawful presence.
We encourage all members of the community—citizens and immigrants alike—to decline to answer when asked by hospital staff for information about their immigration status or lawful presence in the U.S. Everyone in Texas has a legal right to access emergency medical care regardless of their immigration status, and they should not have to unnecessarily disclose sensitive personal information to do so.
Regardless of our citizenship or immigration status, all Texans can protect one another’s right to access emergency medical care by refusing to provide information about our citizenship or immigration status. The more common it becomes for all patients to decline to provide information about their immigration status in healthcare settings, the less intimidating it will feel for our undocumented neighbors and their lawfully present family members to seek medical care when they need it.
Undocumented immigrants and their families are an integral part of our communities. They are our neighbors, our coworkers, and our classmates. Undocumented immigrants are also taxpayers who collectively contributed $4.7 billion to Texas in state and local taxes in 2022 alone, and their payroll deductions help fund federal benefit programs that they themselves are ineligible for, like social security and Medicare. Let’s stand together to protect our communities’ rights and health by declining to answer.
Hundreds of thousands of children in Texas already lack access to regular medical care—Executive Order GA-46 imposes additional potential barriers for many children to access the care they need.
In September 2024, the U.S. Census Bureau released data showing that Texas has the nation’s highest rate of uninsured children (11.9%). According to data from HHSC, more than 2 million Texans lost health insurance coverage during Medicaid “unwinding,” the process in which states reviewed the eligibility of everyone enrolled in Medicaid as continuous coverage requirements implemented during the pandemic came to an end. Analysis released by the Protecting Immigrant Families Coalition in October 2024 found that out of the 10 states studied, Texas performed the worst at mitigating Medicaid coverage losses during the unwinding. The analysis also showed that people in immigrant families have been especially vulnerable to losing health insurance: counties where immigrants make up a higher share of the population saw excess disenrollments of 461,644 people statewide.
Previous policies have similarly discouraged immigrants and their family members from accessing critical services in the past.
Executive Order GA-46 is not the first policy to discourage immigrant families from accessing essential services by creating an atmosphere of fear. Trump-era changes to the “public charge” rule have had significant chilling effects, leading many in immigrant families to avoid enrolling in health insurance and other federal programs. When an immigrant applies for lawful permanent residency, immigration officers assess whether that person is likely to become a “public charge”—primarily dependent on government aid. Immigrants deemed likely to be a public charge will be denied adjustment of status in the U.S.
The Trump administration’s proposed expansion of the definition of “public charge” and changes to the public charge rule left people in immigrant and mixed-status families fearful and uncertain about using public services, worrying it might impact their immigration status. This deterred immigrant households from using public benefits, cutting off low-income children—many U.S. citizens—from crucial access to health care and nutrition assistance during key developmental stages.
Under the Biden administration’s current public charge rule, only public cash assistance and government-funded long-term institutional care are considered when applying the public charge test. This means eligible immigrants can safely enroll in federal benefits programs like Medicaid, CHIP, and SNAP without risking a “public charge” designation. Similarly, immigrants who are ineligible themselves can safely enroll eligible family members.
Despite the current public charge rule under the Biden administration, lingering misinformation and fear from Trump-era changes still deter many eligible immigrant and mixed-status families from enrolling in Medicaid and other federal benefits. The misconception that accessing these programs could jeopardize their chances of obtaining permanent status leads to many Texas children—many of whom are U.S. citizens—going without health insurance and essential resources.
All children deserve access to medical care, and when children in immigrant families get the care they need, all Texans benefit.
Regular access to medical care throughout childhood lays a foundation for lifelong health, as inadequate healthcare can lead to long-term negative outcomes. Without preventative care, children face more serious illnesses and poorer health overall. Additionally, the consequences of limited healthcare access extend beyond health; a parent’s deteriorating health can result in missed work or job loss, destabilizing the family financially and exposing children to hunger or housing insecurity. Timely access to preventative and emergency care can be the difference between life and death.
CDF-Texas believes we have a moral duty to care for children and that everyone deserves access to life-saving medical care, regardless of their parentage, immigration status, or place of birth. We echo the sentiments of the late former President and CEO of Parkland Health and Hospital System in Dallas County, Ron J. Anderson, MD, who stated that providing preventative care to all—including undocumented immigrants and their children—is in the best interest of all Texans.
The best way to protect the health of all Texans is to ensure that everyone in our community has access to necessary health care.
To learn more about Executive Order GA-46 and how you can respond, please click here to access Know Your Rights guides for patients in English and Spanish, and Advisory memo for medical providers, and other resources developed by the Texas Immigration Law Council, Texas Civil Rights Project, Worker’s Defense Project, Every Texan, and ACLU of Texas.
Author
Trudy Taylor Smith
Senior Administrator of Policy and Advocacy
This blog post is intended to provide general information and does not constitute legal advice.