H.R. 6801: American Citizenship Healthcare Integrity Act of 2025
Sponsor
Nancy Mace
Republican · SC-1
Bill Progress
Latest Action · Dec 17, 2025
Referred to Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
Hospitals would ask every patient if they're a citizen
Why it matters
Nearly every hospital in the country takes Medicare. This bill would make asking patients about citizenship a condition of staying in the program, putting the question on intake forms within 180 days and starting annual reports on the cost of care for noncitizens within a year.
H.R. 6801 doesn't create a program or spend money. It adds a requirement to the rules hospitals already follow to stay in Medicare.
Starting 180 days after it becomes law, hospitals, critical access hospitals, and rural emergency hospitals would have to ask on each intake form whether the patient is a citizen or national of the United States. Within a year, and every year after, they'd report two numbers to the federal government: how many noncitizen patients they treated, and the dollar amount of uncompensated care those patients received.
The federal government would then publish its own annual report — adding up that uncompensated care nationwide and estimating how much Medicare and Medicaid spending it attributes to it.
Supporters frame the bill as cost transparency. Critics argue a citizenship question at the hospital door could discourage some people from seeking care, even though the bill itself only requires asking the question and counting the costs.
H.R. 6801 Bill Summary
What H.R. 6801 actually does.
A citizenship question on every intake form
Beginning 180 days after enactment, hospitals, critical access hospitals, and rural emergency hospitals would have to ask on each intake form, or its equivalent, whether the patient is a citizen or national of the United States.
Annual hospital reports on noncitizen care
Within one year of enactment, and every year after, covered hospitals would report to the Secretary how many patients they treated who are not citizens or nationals, along with the dollar amount of uncompensated care provided to them.
A public federal report on the costs
The Secretary would publish an annual report adding up nationwide uncompensated care for noncitizens and estimating the Medicare and Medicaid spending the Secretary determines would not have happened without it.
Medicare participation is the only enforcement
The bill makes asking the question and filing the reports a condition of participating in Medicare, rather than setting a separate fine or criminal penalty. Hospitals that don't comply would put their Medicare standing at risk.
Who benefits from H.R. 6801?
Lawmakers tracking immigration and health spending
They'd get recurring national data — starting within a year of enactment — on how many noncitizen patients hospitals treat and the cost of uncompensated care tied to them, instead of relying on one-off estimates.
People who want public health-spending data
The Secretary would have to publish the uncompensated-care totals and related Medicare and Medicaid figures every year, making them part of the public record.
Supporters of stricter immigration-linked accounting
The bill would build a nationwide reporting system across hospitals, critical access hospitals, and rural emergency hospitals, with the citizenship question required at intake nationwide.
Who is affected by H.R. 6801?
Hospitals, critical access hospitals, and rural emergency hospitals
They would have to revise intake forms within 180 days and stand up annual reporting systems that count noncitizen patients and calculate the uncompensated care provided to them.
Patients who are not citizens or nationals
They would be asked about citizenship on each intake form, and the care they receive would be counted in hospital and federal reports on uncompensated care.
Every patient who fills out an intake form
The citizenship question would appear on intake paperwork for everyone, since the requirement applies to each form regardless of the patient's status.
Hospital compliance and billing staff
They'd collect a new data point on every covered encounter and build the systems to total both patient counts and uncompensated-care dollars each year.
HR6801 Legislative Journey
House: Committee Action
Dec 17, 2025
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
About the Sponsor
Nancy Mace
Republican, South Carolina's 1st congressional district · 5 years in Congress
Committees: Armed Services, Oversight and Government Reform, Veterans' Affairs
View full profile →
Cosponsors (1)
This bill has 1 cosponsor: 1 Republican. Cosponsors represent 1 state: Colorado.
Committee Sponsors
Energy and Commerce Committee
0 of 54 committee members cosponsored
No committee members have cosponsored this bill
Ways and Means Committee
0 of 45 committee members cosponsored
No committee members have cosponsored this bill
56 Republicans across these committees haven't cosponsored yet. Mobilize their constituents
H.R. 6801 Quick Facts
- Committee
- Energy and Commerce
- Chamber
- House
- Policy
- Health
- Introduced
- Dec 17, 2025
Referred to Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. for review
Dec 17, 2025
Official Sources
Official Congress.gov page for the American Citizenship Healthcare Integrity Act of 2025 with bill text, status, and actions.
Official CMS page covering hospital participation and compliance standards relevant to how this bill would apply to hospitals in Medicare.
Official CMS resource for critical access hospitals, one of the facility types expressly covered by the bill.
Official Medicaid site relevant because the bill requires HHS to estimate related federal expenditures under title XIX.
Official Social Security Administration compilation of title XVIII, which the bill amends through section 1866 of the Social Security Act.
Official text of section 1866 of the Social Security Act, the statutory Medicare provider agreement section directly amended by the bill.
Official HHS homepage relevant because the Secretary of HHS would be responsible for the required annual public reporting under the bill.
H.R. 6801 Common Questions
What would H.R. 6801 actually require hospitals to do?
Two things: ask every patient on their intake form whether they're a citizen or national of the United States, and report each year how many noncitizen patients they treated plus the dollar amount of uncompensated care those patients received.
Could a hospital lose Medicare if it doesn't ask patients about citizenship?
Yes. H.R. 6801 makes asking the question and filing the reports a condition of participating in Medicare, so a hospital that doesn't comply would put its Medicare standing at risk. There's no separate fine written into the bill.
Would being asked about citizenship affect my hospital care?
The bill only requires hospitals to ask the question and count the cost of unpaid care. It doesn't direct hospitals to deny treatment or report patients' answers to immigration authorities.
Which hospitals would have to ask patients about citizenship?
Hospitals, critical access hospitals, and rural emergency hospitals that participate in Medicare. Because nearly all hospitals take Medicare, the requirement would reach most of the country.
When would hospitals start asking the citizenship question?
180 days after the bill becomes law. From that point, the question would have to appear on each intake form, or an equivalent form, for patients receiving hospital services.
Would the government make these numbers public?
Yes. Within a year of enactment and every year after, the HHS Secretary would publish a report on nationwide uncompensated care for noncitizens and the Medicare and Medicaid spending the Secretary attributes to it.
Does H.R. 6801 set any fine or penalty for hospitals?
No. The bill names no dollar fine or criminal penalty. Its only enforcement is tying compliance to a hospital's participation in Medicare.
Based on H.R. 6801 bill text
H.R. 6801 Bill Text
“To amend title XVIII of the Social Security Act to require hospitals to ask the citizenship status of patients as a condition of participation in the Medicare program and to require reports on the cost of furnishing hospital services to noncitizens.”
Source: U.S. Government Publishing Office
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