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
Why it matters
If enacted, HR6801 would begin changing hospital intake paperwork within 180 days and trigger federal reporting within 1 year on how much uncompensated care is provided to patients who are not citizens or nationals of the United States.
What the bill does not do is just as important. The fact sheet specifies no new funding, no grant program, no exemption categories, and no direct civil or criminal fine amounts. Instead, enforcement runs through Medicare participation rules for hospitals, critical access hospitals, and rural emergency hospitals. Supporters are likely to frame that as a transparency and cost-accounting measure; critics are likely to argue it could discourage some patients from seeking care even though the bill’s operative requirement is an intake question and annual reporting.
What does H.R. 6801 do?
Citizenship question required within 180 days
Beginning 180 days after enactment, hospitals, critical access hospitals, and rural emergency hospitals would have to ask on each intake form, or an equivalent form, whether the individual is a citizen or national of the United States.
Annual hospital reports start by year 1
Not later than 1 year after enactment, and annually thereafter, covered hospitals must report to the Secretary the number of individuals furnished items or services who are not citizens or nationals of the United States.
Hospitals must report uncompensated care dollars
Those same annual reports, due not later than 1 year after enactment and every year after that, must include the dollar amount of uncompensated care furnished to individuals who are not citizens or nationals of the United States.
Secretary must publish Medicare and Medicaid estimates
Not later than 1 year after enactment, and annually thereafter, the Secretary must publicly report the dollar amount of uncompensated care for individuals who are not citizens or nationals of the United States and the amount of federal expenditures under Title XVIII (Medicare) and Title XIX (Medicaid) that would not have been made in the absence of that uncompensated care.
Medicare participation becomes the enforcement tool
The bill makes these requirements a condition of participation in the Medicare program under section 1866 of the Social Security Act, applying the rule through existing federal hospital participation standards rather than specifying a separate fine amount or criminal penalty.
Who benefits from H.R. 6801?
Federal policymakers overseeing Medicare and Medicaid
They would receive annual data, starting not later than 1 year after enactment, on the number of non-citizen or non-national patients served, the dollar amount of uncompensated care tied to them, and estimated related spending under Title XVIII and Title XIX.
Voters focused on health spending transparency
The bill requires the Secretary to make public annual figures on uncompensated care and related Medicare and Medicaid expenditures, giving the public recurring federal data rather than one-time estimates.
Supporters of stricter immigration-linked reporting
They would get a nationwide reporting system covering hospitals, critical access hospitals, and rural emergency hospitals, with the intake question required on each form beginning 180 days after enactment.
Who is affected by H.R. 6801?
Hospitals, critical access hospitals, and rural emergency hospitals
These facilities would need to revise intake forms within 180 days after enactment and then submit reports not later than 1 year after enactment and annually thereafter with patient counts and uncompensated care dollar amounts.
Patients who are not citizens or nationals of the United States
They would be directly asked about citizenship or national status on each intake form, and care provided to them would be counted in annual hospital and federal reports on uncompensated care.
Hospital administrative and compliance staff
They would have to collect a new intake data point for every patient encounter covered by the form requirement and build annual reporting systems to calculate both the number of affected individuals and the dollar amount of uncompensated care.
The Secretary administering federal health reporting
The Secretary would be required, not later than 1 year after enactment and annually thereafter, to publish hospital-based uncompensated care totals and estimates of related federal spending under Medicare and Medicaid.
H.R. 6801 Common Questions
Can hospitals lose Medicare participation if they do not ask patients about citizenship under HR6801?
Yes. Under the American Citizenship Healthcare Integrity Act of 2025 (Section 2), asking about citizenship and filing the required reports become conditions of participation in Medicare.
How soon would hospitals have to add a citizenship question to intake forms under the American Citizenship Healthcare Integrity Act?
Covered facilities would have 180 days after enactment to begin asking on each intake form whether the person is a U.S. citizen or national under the American Citizenship Healthcare Integrity Act of 2025 (Section 2).
Which healthcare facilities would have to ask patients if they are U.S. citizens or nationals under HR6801?
According to HR6801 Section 2, the requirement applies to hospitals, critical access hospitals, and rural emergency hospitals participating in Medicare.
Does HR6801 require hospitals to report uncompensated care costs for non-citizen patients?
Yes. Under the American Citizenship Healthcare Integrity Act of 2025 (Section 2), hospitals must annually report the dollar amount of uncompensated care furnished to individuals who are not U.S. citizens or nationals.
How much information would hospitals have to report each year under the American Citizenship Healthcare Integrity Act?
Under Section 2, hospitals must report two key items each year: the number of non-citizen/non-national individuals served and the dollar amount of uncompensated care provided to them.
Does HR6801 require HHS to publicly release Medicare and Medicaid cost estimates tied to uncompensated care?
Yes. According to HR6801 Section 2, the HHS Secretary must publicly report uncompensated care totals and the Medicare and Medicaid spending that would not have occurred without that uncompensated care.
When would the first hospital reports be due under the American Citizenship Healthcare Integrity Act of 2025?
The first hospital report would be due no later than 1 year after enactment, with annual reports after that, under the American Citizenship Healthcare Integrity Act of 2025 (Section 2).
When would HHS have to publish the first public report under HR6801?
Under HR6801 Section 2, the Secretary of HHS must make the first public report available no later than 1 year after enactment and then update it annually.
Can a hospital use an equivalent form instead of the main intake form to ask about citizenship under HR6801?
Yes. According to HR6801 Section 2, the question may appear on each intake form or an equivalent form, as long as the individual is asked whether they are a U.S. citizen or national.
Does the bill ask whether a patient is a U.S. citizen or also whether they are a U.S. national?
It asks about both. Under the American Citizenship Healthcare Integrity Act of 2025 (Section 2), facilities must ask whether the individual is a citizen or national of the United States.
Based on H.R. 6801 bill text
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 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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