Starting Friday, Texas hospitals must ask patients if they are in the U.S. legally and track the cost of treating people without legal status, following an order by Republican Gov. Greg Abbott that widens the state’s standoff with the Biden administration over immigration.

Critics fear the change could 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 debuted last year in Florida, where Republican Gov. Ron DeSantis is also a frequent critic of the federal government’s handling of illegal crossings along the US-Mexico border.

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

PREVIOUS REPORT: Governor Abbott signs order requiring Texas hospitals to inquire about patients’ immigration status

Here’s what you need to know:

It is asked to ask, not to answer

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

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

Track hospital costs and patient data

Hospitals are not required to begin sending reports to the state until March. An initial draft of a spreadsheet made by state health officials to track data does not include fields to submit patient names or personal information.

Providers will complete a breakdown of inpatient and urgent care patient visits and document whether they are lawfully present in the country, citizens, or not lawfully present in the US

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

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

Texas is following Florida’s lead

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

Early Florida dates are limited – by state admission. Data are self-reported. Anyone can opt out, an option chosen by nearly 8 percent of people admitted to the hospital and about 7 percent of people who went to the emergency room from June to December 2023, according to the Florida state report. Less than 1% of people who went to the emergency room or were admitted to the hospital said they were in the US “illegally.”

Hospitals in Texas have prepared

Immigrant and health care advocates sought to educate the Texas public about their rights. In Florida, groups used text messages, posters and emails to spread the word. But advocates there said they haven’t seen the fears subside for about a year.

Health care 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 continue to be a safe place for needed care,” said Carrie Williams, spokeswoman for the hospital association.