Texas hospitals must ask patients whether they are legally in the U.S. starting Friday and track the cost of treating people without legal status under Republican Gov. Greg Abbott’s order that widens the state’s conflict with the Biden administration on immigration.

Critics fear the change could drive people away from hospitals in Texas, even though patients don’t have to answer questions to receive medical care. The authority is similar to a policy launched last year in Florida, where Republican Gov. Ron DeSantis has also frequently criticized the federal government’s handling of illegal crossings at the U.S.-Mexico border.

Texas hospitals have spent months preparing for this change, trying to reassure patients that it won’t impact their level of care.

PREVIOUS REPORT: Governor Abbott signs order requiring hospitals in Texas to obtain information on patients’ immigration status

Here’s what you need to know:

It is necessary to ask, it is not necessary to answer

Under the executive order that Abbott announced in August, hospitals are required to ask patients whether they are U.S. citizens and whether they are in the country legally.

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

Track hospital costs and patient data

Hospitals do not need to submit reports to the state until March. The first draft of the spreadsheet prepared by state health officials to track the data does not include fields to submit patient names or personal information.

Providers will complete a transcript of visits for inpatient and urgent care patients and document whether these patients are in the country legally and whether citizens are legally present in the United States.

The reports will also include costs for those covered by the Children’s Health Insurance Program, known as Medicaid or CHIP; and the cost to patients without it.

“Texans should not have to shoulder the burden of subsidizing medical care for illegal immigrants,” Abbott said when he announced the policy.

Texas follows in Florida’s footsteps

Florida enacted a similar law last year. Health advocates argue that the law scares immigrants who need emergency medical care, leading to fewer people seeking help even from facilities not subject to the law.

Florida’s initial data is — as the state acknowledges — limited. Data is self-reported. Anyone can refuse to answer, an option chosen by about 8% of people admitted to the hospital and about 7% of people going to the emergency room from June to December 2023, according to a Florida state report. Less than 1% of people who went to the emergency room or were hospitalized reported being in the United States “illegally.”

Texas hospitals are preparing

Immigrant and healthcare advocates have tried to educate Texas residents about their rights. In Florida, groups used text messages, posters and emails to get the word out. But advocates there said they haven’t seen the fears ease in nearly a year.

Healthcare providers received directives from the state and guidance from the Texas Hospital Association.

“The bottom line for patients is that this does not change hospital care. Texas hospitals remain a safe place to get needed care,” said Carrie Williams, a spokeswoman for the hospital association.