Hospitals Must Ask Every Patient’s Citizenship Status to Keep Medicare Funding Under New Bill

The “American Citizenship Healthcare Integrity Act of 2025” aims to change how hospitals operate by tying Medicare participation directly to patient intake forms. Specifically, Section 2 of this bill mandates that hospitals, critical access hospitals, and rural emergency hospitals must ask every single patient about their U.S. citizenship or national status starting 180 days after the law is enacted. If a hospital doesn't add this citizenship question to their intake forms, they risk losing their ability to participate in Medicare—a massive financial lifeline for nearly every healthcare facility in the country.

The New Paperwork Trail: Who Pays for Uncompensated Care?

This isn't just about asking a question; it’s about creating a new national data set focused on healthcare costs. The bill requires hospitals to report annually on two key metrics related to non-citizens: the number of non-citizen patients they treated and the total dollar amount of uncompensated care furnished to those individuals. Think about the administrative lift here: every hospital system now has to track, categorize, and report this specific financial data point to the Secretary of Health and Human Services (HHS). For the hospital CFOs and administrators already struggling with staffing and rising supply costs, this is a brand-new, mandatory reporting burden.

The Chilling Effect in the ER

While the bill doesn't say hospitals must deny care based on status, the requirement to ask and report creates a significant real-world problem for access. Imagine you’re a non-citizen—maybe a green card holder, maybe undocumented, maybe someone here on a work visa—and you need emergency care. If you know that seeking treatment means giving specific information about your status that gets reported to the federal government, you might delay or avoid the hospital altogether. This is called a “chilling effect,” and it’s a major concern for public health experts because delayed care often turns minor issues into expensive, life-threatening emergencies, ultimately increasing healthcare costs for everyone.

Public Reporting and Policy Impact

The final piece of the bill requires the Secretary of HHS to publicly report the national totals of uncompensated care provided to non-citizens. This report must also include an estimate of how much federal money—specifically Medicare and Medicaid expenditures—was spent that “would not have been made in the absence of that uncompensated care.” This provision is clearly intended to provide ammunition for future policy debates, assigning a specific dollar amount to the costs associated with non-citizen healthcare. However, the methodology for accurately calculating what Medicare or Medicaid expenditures “would not have been made” is complex and wide open to interpretation, potentially leading to reports that are more political than purely factual.