Texas Sets the Standard

Texas leads the nation in uninsured residents – but it also leads in stepping up for them. That’s not a coincidence. It’s a choice our hospitals make every day, and one worth defending.

John Hawkins, President/CEO, Texas Hospital Association — Hawkins

Charity care and community benefits are essential to the well-being of our state, representing two distinct ways hospitals give back directly to the communities they serve. Charity care encompasses free and discounted care provided to patients facing financial hardship. Community benefits, meanwhile, capture the broader universe of hospital investments that improve community health – from health education and screenings to subsidized services and community health improvement initiatives. Scrutiny is increasing over whether nonprofit hospitals are doing enough to demonstrate their positive impact and justify their tax breaks. Here in Texas, the evidence could not be clearer: nonprofit hospitals are good citizens and invest extraordinary resources to ensure every Texan can lead a healthy life.

Texas law sets the bar high for giving back and investing in our communities, with one of the most stringent state-level charity care laws in the country. Nonprofit hospitals are required by law to deliver minimum amounts of charity care every year; most of them do so by devoting at least 5% of net patient revenue to community benefits, of which 4% must be charity care. Failing to meet the state’s minimum standards puts a hospital’s tax exemption at risk. When we say everything is bigger in Texas, that includes the scale of community investments. In 2024, Texas nonprofit hospitals provided $14.9 billion in unreimbursed low-income charity care, Medicaid shortfall, and community benefits. This surpasses the state law’s charitable minimum requirements by approximately $12.6 billion, or 467%.

For every dollar of state and local tax benefit it receives, the average Texas nonprofit hospital provides $12 in charity care and $33 in community benefits. State data repeatedly bear out that nonprofit hospitals ensure the Texas taxpayer receives a return on their investment orders of magnitude greater than the amount they would otherwise pay.

Charity care and community benefits take many forms across the state. In rural communities, hospitals invest in chronic disease management programs and prescription assistance to ensure patients can access care without having to travel hours from home. In urban areas, hospitals partner with community organizations to provide free vaccination clinics, maternal health services and preventative care. For example, Texas Health Resources launched the Wellness for Life mobile clinic and has provided cancer screenings and other health care services to over 95,000 men and women in the Dallas-Fort Worth area since 1993. In 2025, the mobile units visited 309 sites across 12 counties and more than 9,300 miles.

Each effort looks different because every community’s needs are different – but the throughline is the same: hospitals meeting Texans where they are.

That is what community benefits look like. It is not limited to educational brochures or one-time outreach events. It is a sustained investment in the health of Texans, in ways that are central to their charitable missions and make a significant difference in people’s lives.

As policymakers continue to examine nonprofit hospitals’ tax status and community benefit obligations, they should do so with a full understanding of the facts. Texas hospitals are not simply meeting statutory requirements – they are exceeding them by billions of dollars while caring for one of the nation’s largest uninsured populations. Weakening that partnership or mischaracterizing its impact risks undermining services that communities rely on every day.

These deliberate investments by hospitals serve patients regardless of their ability to pay, increase access to care and address the unique needs of communities across Texas. That’s a commitment worth recognizing, protecting and strengthening.