Texas hospitals must survey patients starting Friday if they are legally in the United States and track the cost of treating people without legal status following an order of Republican Governor Greg Abbott it widens the conflict between the state and the Biden administration over immigration.

Critics fear the change will scare people away from Texas hospitals, even though patients are not required to answer questions to receive medical care. The mandate is similar to a policy that began last year in FloridaOr Republican Governor Ron DeSantis is also a frequent critic of the federal government’s handling of illegal crossings along the U.S.-Mexico border.

Texas hospitals spent months preparing for the change and sought to reassure patients that it would not affect their level of care.

Here’s what you need to know:

Obligation to ask, no obligation to answer

Under the executive order announced by Abbott in August, hospitals must ask patients if they are U.S. citizens and legally present in the country.

Patients have the right to withhold this information, and hospital staff must tell them that their responses will not affect their care, as required by federal law.

Tracking hospital costs and patient data

Hospitals are not required to begin submitting reports to the state until March. An early draft of a spreadsheet state health officials made to track the data does not include fields for submitting patient names or their personal information.

Providers will complete a breakdown of inpatient and urgent care patient visits and indicate whether they are legally present in the country, citizens, or not legally present in the United States.

The reports will also add up costs for those covered by Medicaid or the Children’s Health Insurance Program, known as CHIP; and the cost for patients who do not have one.

“Texans should not have to bear the burden of financially supporting the medical care of illegal immigrants,” Abbott said when announcing the policy.

Texas follows Florida’s lead

Florida adopted a similar law last year. Health care advocates say the law has made immigrants who need emergency medical care fearful and led to fewer people seeking help, even at facilities not subject to the law.

The first data from Florida are — by the state’s own admission — limit. Data is self-reported. Anyone can refuse to answer, an option chosen by nearly 8% of people admitted to the hospital and about 7% of people who visited the emergency room from June to December 2023, according to the state report. Florida. Less than 1% of people who visited the emergency room or were admitted to the hospital reported being in the United States “illegally.”

Texas hospitals are preparing

Immigrant and health care advocates have sought to educate the Texas public about their rights. In Florida, groups used text messages, posters and emails to get the message out. But advocates of the project said they didn’t see the fears easing for about a year.

Health care providers have received guidance from the state and guidance from the Texas Hospital Association.

“Ultimately, for patients, it makes no difference to hospital care. Texas hospitals continue to be a safe place for needed care,” said Carrie Williams, a spokesperson for the hospital association.