Chip Roy

A Republican Congressman has introduced a bill which would require hospitals to report the immigration status of patients, arguing this would deliver transparency for taxpayers."

Texas Representative Chip Roy, who has been a strong supporter of pausing all immigration into the United States and backed President Donald Trump's enforcement efforts, said the bill would require hospitals receiving federal health care funding to ask patients for their immigration status.

It is understood the bill is aimed at recording the cost to the health care system of treating migrants without legal status, and that failure to answer will not mean care is denied.

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The move comes after some states, including Texas and Florida, have sought information on immigrants receiving health care through Medicare and Medicaid programs. Those efforts have seen pushback from immigrant and patient advocacy groups, which argue that anyone, regardless of immigration status, is eligible to receive emergency care.

"For years, Americans have watched overcrowded emergency rooms, rising health care costs, and strained hospital resources while being kept in the dark about the potential billions of taxpayer dollars spent on health care for those who are in the country illegally," Roy said in a press release.

"That lack of accountability is unacceptable and absurd. The Illegal Alien Patient Reporting Act delivers the transparency and accountability Americans deserve by ensuring hospitals report the extent to which illegal aliens are adding to the fiscal burden of our health care system."

What The Law Says About Immigrants and Health Care

Federal law does not generally require hospitals to verify or report a patient's immigration status before providing treatment.

The key provision is the Emergency Medical Treatment and Labor Act (EMTALA), which was enacted in 1986. EMTALA requires Medicare-participating hospitals with emergency departments to:

Screen anyone who comes to the emergency room seeking care.

Stabilize patients who have an emergency medical condition.

Provide that care regardless of ability to pay, insurance status, or immigration status.

In practice, that means an undocumented immigrant who arrives at an ER with a medical emergency is entitled to emergency screening and stabilizing treatment just like a U.S. citizen.

However, undocumented immigrants are generally excluded from most federal public health insurance programs, including regular Medicaid, Medicare, and Affordable Care Act marketplace coverage.

As Newsweek fact-checked in September 2025, immigrants without legal status are largely barred from Medicaid, Medicare, and ACA coverage, although emergency care may still be reimbursed through emergency Medicaid provisions.

Can Hospitals, Doctors Ask About Immigration Status?

Generally, yes, as there is no broad federal prohibition on hospitals or physicians asking a patient about immigration or citizenship status. Hospitals routinely ask many demographic questions during intake, and immigration status can be one of them if the provider chooses to collect that information.

What is important, legal experts have noted, is that patients are not required to answer the question.

This became a major issue in Texas after Governor Greg Abbott's 2024 executive order requiring hospitals to collect and report data about undocumented patients. According to guidance cited by the ACLU of Texas, hospitals must ask the question, but patients can decline to answer, and the order explicitly states that their response will not affect care.

Similarly, reporting on Texas hospitals found that providers were telling patients they did not legally have to answer questions about citizenship status, even though hospitals were required to ask.

What Would Chip Roy's Bill Change?

The proposal would move beyond current federal law by requiring hospitals participating in federal health programs to:

Ask patients, during admission or registration, to indicate whether they are:

U.S. citizens,

lawful permanent residents,

present on a valid visa, or

otherwise lawfully present in the United States.

Submit periodic reports to the federal government containing immigration-status data.

Face loss of participation in federal health programs if they fail to comply.

The bill does say that the intake forms would also have to state that a patient's answer would not affect their medical care.

Joe Chatham, Director of Government Relations at the Federation for American Immigration Reform, in a press release announcing the bill, said that this was a way to address the "true cost of illegal immigration to American taxpayers."

"For decades, Washington has hidden the health care cost of illegal immigration and handed American taxpayers the bill," Chatham said. "Florida finally asked the question and found taxpayers paid $566 million in one year. Nationally, the cost is already estimated at least $21 billion, and that may be the floor."

What Happens Next

Roy's bill will need to face scrutiny in Congress, through committee, House, and Senate hearings before it can become law.