June 17, 1987 

Eonorable Robert E. (Bobby) Bell Opinion No. JM-722 

Criminal District Attorney 

115 w. Main Re: Whether Jackson County is 

Edna, Texas 77957 required to provide services under 

the Indigent Health Care Act where 

the county is encompassed within a 

hospital district 

Dear Mr. Bell: 

You ask whether Jackson County is liable under the Indigent 

Health Care and Treatment Act for health care services for indigent 

residents of that county. We conclude that the county is not liable 

for either Inpatient or outpatient health and medical services. 

The Jackson County Hospital District is created under authority 

of article IX, section 9, of the Texas Constitution, by chapter 275, 

66th Legislature, 1979, which is known as the Jackson County Hospital 

District Act. Se& V.T.C.S. art. 4494q. The district includes all of 

Jackson County. -Hence, all indigent residents of the county are 

residents of the hospital district. 

section 9, of article IX, of the Texas Constitution provides in 

part that: 

The Legislature may by law provide for the 

creation, establishment, maintenance and operation 

of hospital districts . . . providing that any 

district so created shall assume full responslbility for providing medical and hospital care for 

its needy inhabitants . . . providing that after 

its creation no other municipality or political 

subdivision shall have the power to levy taxes or 

issue bonds or other obligations for hospital 

purposes or for providing medical care within 

the boundaries of the district. . . . (Emphasis 

added). 

The Jackson County Hospitai District Act provides in part that: 

Sec. 16. Whenever a patient residing within 

the district is admitted to the facilities of the 

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Honorable Robert E. (Bobby) Bell - Page 2 (JM-722) 

district, the administrator for the hospital to 

which the patient is admitted may have an inquiry 

made as to his or her circumstances and those of 

the relatives of the patient legally liable for 

his or her support. . . . If the administrator 

finds that the patient or his or her relatives are 

not. able to pay either in whole or in part for 

care and treatment in the hospital, they shall 

become a charge on the hospital district as to the 

amount of the inability to pay. . . . 

. . . . 

Sec. 20. . . . The board shall provide for the 

administration, maintenance, and operation of 

both hospitals transferred to the district on its 

creation so as to furnish adequate hospital and 

medical care within the district and to ensure 

that each hospital is provided with sufficient 

funds, personnel, and equipment to the end that 

residents of the district have access to quality 

and competent health facilities; and no other 

municipality or political subdivision may levy 

tames or issue bonds or other obligations for 

hospital purposes or for providing medical care 

within the boundaries of the district. The 

district shall assume full responsibility for 

providing medical and hospital care for its needy 

inhabitants. (Emphasis added). 

Acts 1979. 66th Leg., ch. 275, at 595-98. 

When a hospital district is created ,for the county pursuant to 

article IX, section 9, of the Texas Constitution, the county constitutionally does not have the power to levy or use taxes to provide for 

medical services for indigent residents of the hospital district, as 

such power and obligation rests exclusively on the hospital district. 

Attorney General Opinion C-646 (1966). See also Attorney General 

Opinion Nos. M-870 (1971); C-334 (1964). 

The provisions of the Indigent Eealth Care and Treatment Act, 

article 443Sf. V.T.C.S., are consistent with, and adopt by reference, 

the provisions of both article IX, section 9, of the Texas Constitution and the Jackson County Eospital District Act. Title 2 of the 

Indigent Health Care Act specifies the responsibility of a county for 

health care assistance to the county's eligible residents who do not 

reside in an area served by a public hospital or hospital district. 

Sets. 2.01, 2.02(a), 3.01, .4.01. Since all of Jackson County Is 

served by the hospital district, the provisions of Title 2 fixing 

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Honorable Robert E. (Bobby) Bell - Page 3 (JM-722) 

liability of a county for indigent health care have no application to 

Jackson County. 

Title 3 of the act applies to and determines liability for health 

care for persons who reside in an area served by a public hospital or 

hospital district. Sec. 10.01(a). We note that, under the Indigent 

Health Care Act, a hospital district is not a "governmental entity." 

Sec. 1.02(6). Hence, a facility of a hospital district is not a 

"public hospital" within the meaning of that act and the provisions 

of the act that apply to "public hospitals" are not applicable to 

hospital districts. 

Section 11.02 of Title 3 provides that "[a] hospital district 

shall provide the health care services required under the Texas 

Constitution and the statute creating the district." Section 12.01(b) 

states that "[a] hospital district is liable for health care services 

as provided by the Texas Constitution and the statute creating the 

district." 

The Indigent Health Care Act does not alter, or attempt to alter, 

the responsibility of a hospital district for all health care required 

by article IX, section 9, of the Texas Constitution and the Jackson 

County Hospital District Act. It is not an attempt by statute to make 

Jackson County liable for inpatient or outpatient health and medical 

services for indigent residents of that county. 

-SUMMARY 

In a county in which a hospital district 

encompasses the entire county, the county is not 

liable for health care services to indigent residents of the county under any of the provisions 

of the Indigent Eealth Care and Treatment Act. 

Instead, the act specifies that, for indigent 

persons who reside within a hospital district, 

the hospital district is liable for health care 

services as provided by the Texas Constitution and 

the statute creating the hospital district. 

-Jf& 

MATTOX 

Attorney General of Texas 

JACK BIGBTOWER 

First Assistant Attorney General 

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Ronorable Robert E. (Bobby) Bell - Page 4 (JM-722) 

MARYKELLER 

Executive Assistant Attorney General 

JUDGE ZOLLIE STEAKLEY 

Special Assistant Attorney General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by Nancy Sutton 

Assistant Attorney General 

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