QBfficeof tfie JZMmep @eneral
&ate of Qexarl
DAN MORALES
Al-rORNEY
GENERAL June 8.1993
Honorable Clan R Cannon Opiion No. DM-225
Rames County Auditor
200 Bast calvert Re: Liabiity for costs of health care
Kames City, Texas 78118 provided to indigent inmates of the Rames
County Jail (RQ-420)
Dear Mr. Cannon:
You ask who is responsible for paying medical bills for indigent prisoners
inumerated in Kames County Jail. We cannot anticipate all issues that may arise with
respect to responsibiity for the costs of indigent prisoners’ medical care. We offer the
following discussion for your general guidance.
We note first that, for purposes of the following discussion “indigent” will mean
“eligible” as used in the terms “eligible county resident” or “eligible resident” in the
Indigent Health Care and Treatment Act, codiied as chapter 61 of the Health and Safety
Code. See Health & Safety Code 5 61.002(3). (4) (detinitions). That act provides
generally for hospital districts’ or public hospitals’ responsibiity for the costs of providing
medical care for their “eligible residents,” id subch. C, and for counties’ responsibiity for
such costs for “eligible county residents,” i.e., those who do not reside in the service area
of a hospital district or public hospital, id subch. B.
For indigent, or “eligible,” persons who are residents of hospital distticts, section
61.055 of the Indigent Health Care and Treatment Act (the “act”) provides that a hospital
district must provide the he&b care services and treatment required by the constitution
and the district’s enabling legislation. As you indicate, the Rames County Hospital District
has been created in Kames County and is coextensive with the county. Acts 1%9,61st
Leg., ch. 591. at 1764. The district’s enabling act and the constitution require the district
to provide medical care for its needy residents or inhabitants. Id 6 3; Tex. Const. art. Iy
5 9. Prior opinions of this office have consistently opined that a hospital district’s duty to
provide medical care for their indigent residents extends to such residents when they are
held in county jails. Attorney General Qpiions JM-643 (1987); JM-487 (1986); H-703
(1975). Thus, it is our opinion that the ICames County Hospital District is responsible for
the medical costs of an indigent jail inmate who is a resident of that district. See generally
Health & Safety Code ch. 61, subch. C.
p. 1172
Honorable Clem R Cannon - Page 2 (DM-225)
Also, for such an indigent imnate who is a resident of another hospital district, the
hospital district of his residence is responsible for the costs of medical care, pursuant to
that district’s enabling legislation and the requirements of the constitution. Attorney
General Opiions JM-643; JM-487. As noted in Attorney General Opiion JM-643 in
1987, despite the indication in subpart (a) of article 104.002 of the Code of Criminal
Procedure and its predecessor provisions that the county is liable for the medical expemes
of its prisoners, the express provisions of the constitution, making hospital districts, where
created, responsiile for the medical care of their needy inhabitan@ must be read to
prevail, even in the situation where such a hospital district’s resident receives medical care
while ineed in another county’s jail.
Similarly, for indigent inmates of the Karnes County Jail who reside in the service
area of a public hospital, it is the public hospital which is ultimately responsible for the
cost of health care provided at the jail. See He&b & Safety Code 3 61.052 (public
hospital’s responsibiity for eligible residents of its service area); see uko id. $5 61.002(11)
(detinhion of public hospital), 61.051(b) (hospitals not considered public hospitals),
61.054 (service obligations), 61.060 (liability for payment for services provided).
With respect to an indigent inmate of the Karnes County Jail who does not reside
in Karnes County and whose residence is not embraced in any hospital district or public
hospital service area, we note Srst that Attorney General Opiion JM-643 con&ded, in
1987, that the liabiity for medical care of such indigent inmates of a county jail was to be
borne by the county of incarcera tion, and not by the county of residence. Smce the
issuance of Attorney General Opinion JM-643, article 104.002, subpart (d) of the Code of
Crhninal Procedure, has been amended. Subpart (d) anrently provides:
Apersonwhoisorwasaprisonerinacountyjailandreceived
medical, dental, or health related services from a county or a hospital
district shall be required tr, pay for such se&es when they are
rendered. Jf such prisoner is an eligible county resident as defined in
Section 61.002, Health and Safety Code, the county or hospital
district providing the services has a right of subrogation to the
prisoner% right of recovety from any sourw limited to the cost of
aetvices provided. A prisoner, unless the prisoner fitlly pays for the
cost of services received, shall remain obtigated to reimburse the
county or hospital district for any medical, dental, or health services
provided, and the county or hospital district may apply for
reimbursement in the manner provided by Chapter 61, Health and
Safety Code. A county or hospital district shah have the authority to
recover the.amount expended in a civil action.
p. 1173
HonorableClemR Cannon - Page 3 (~~-225)
Acts 1991,72d Leg., ch. 434.8 l(d), at 1597-98.’
ln light of the current provisions of article 104.002(d), it is our opinion the costs of
medical care provided to a prisoner who is an “eligible county resident” as deftned in the
Indigent Health Care and Treatment Act, section 61.002~Le., one who is not a resident of
a hospital district or public hospital service area-are now payable under the latter act.
Section 61.022 of that act makes a county ultimately responsiile for health care for its
“eligible county residents.” Thus, responsibiity for costs of medical care provided to such
an “eligible county resident” when incarcerated in the Karnes County Jail would he
uhimately with his county of residence. See also V.T.C.S. art. 2351, subdiv. 6; Attorney
Oenerd Opiions JM-552 (1986); MW-33 (1979).
In that the question of residence decides the matter of responsibility for medical
care in the instances discussed above, we note the Health and Safety Code provides for
the resolution of residency questions. Health 8c Safety Code 88 61.003,61.004.
Again we caution, that we cannot anticipate or resolve~ah questions that may arise
with respect to indigent prisoners’ he&b care expenses. We speciScaUy note, for example,
that we do not consider here the responsibiity for costs of medical care for prisoners who
are not Texas residents. Also, as the above-quoted provisions of article 104.002(d) clearly
anticipate, Kames County or its hospital district may have recourse to other sources of
payment for indigent ptisoners’ health care costs depending on the thcts of the particular
case. The provisions of the Indigent Health Care and Treatment Act fbrther make it dear
that the above-discussed entities’ ultimate responsiiity for such costs may depend on the
availability of payment from other sources. See, e.g., Health & Safety Code 8 61.022(b)
(wunty as “payor of last resort”). Also, eligibility requirements and the kind of care
covered may vary depending on the particular entity responsible. See, e.g., id. @ 61.008,
61.023,61.052; Attorney General Opinion DM-37 (1991).
p. 1174
Honorable Clan R. Cannon - Page 4 (DM-225)
SUMMARY
Subject to the given caveats, the Kames County Hospital
District is responsible for the wsts of medical care provided to its
indigent residents incarcunted in the Kames County Jail. Other
hospital districts or public hospitals are responsible for such costs
with respect to their indigent residents incar~ed in the Kames
County Jail. The wunty of residence of an indigent inmate of the
Kames County Jail who does not reside in a hospital district or public
hospital service area is responsible for the costs of his medical care.
DAN MORALES
Attorney General of Texas
WILL PRYOR
Fii Assistant Attorney General
MARYKELLER
Deputy Attorney General for Litigation
RENEA HICKS
State Solicitor
MADELElNE B. JOHNSON
Chair, Opiion Committee
Prepared by Wti M. Walker
Assistant Attorney General
p. 1175