June 17, 1987

EonorableRobert E. (Bobby)Bell OpinionNo.JM-722 CriminalDistrictAttorney 115w. Main Re: Whether Jackson County is Edna, Texas 77957 required toprovide servicesunder the IndigentHealth Care Act where the county is encompassedwithin a hospitaldistrict
DearMr. 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 Inpatientor outpatienthealth andmedical 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 residentsof thehospitaldistrict. section 9, of article IX, of the Texas Constitutionprovides 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 forprovidingmedical and hospital care for its needy inhabitants
. . . providing that after its creation no other municipality or political subdivision shallhave the power to levy taxes or issue bonds or other obligations for hospital purposes or for providing medical care within theboundaries of the district.
. . . (Emphasis added). The Jackson CountyHospitaiDistrictAct provides inpart that:

Sec. 16. Whenever a patient residing within the district is admitted to the facilitiesof the

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district, the administrator for the hospital to which the patient is admittedmay have an inquiry made as to his or her circumstancesand those of the relatives of the patient legally liable for his or her support. . . . If the administrator finds that thepatient or his or her relativesare not.able to pay either in whole or in part for care and treatment in the hospital, they shall become a charge on thehospital district as to the amount of the inability topay. . . .

. . . . 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 providingmedical and hospital care for its needy inhabitants. (Emphasisadded). Acts 1979. 66thLeg., ch. 275, at 595-98. When a hospital district is created ,forthe county pursuant to article IX, section 9, of theTexas 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 OpinionNos. M-870 (1971);C-334 (1964). The provisions of the Indigent Eealth Care and Treatment Act, article 443Sf.V.T.C.S., are consistentwith, 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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liabilityof a county for indigenthealth care have no application to JacksonCounty. Title 3 of the act applies to and determines liability for health care for personswho reside in an area servedby 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 Constitutionand 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 IndigentHealth CareAct doesnot alter, or attempt to alter, the responsibilityof a hospitaldistrict for all health care required by article IX, section 9, of the Texas Constitution and the Jackson CountyHospitalDistrictAct. It is not an attemptby statute tomake Jackson County liable for inpatient or outpatient health and medical services for indigentresidentsof 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, thehospital district is liable for health care services as provided by the Texas Constitutionand the statute creating thehospital district.



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MATTOX AttorneyGeneral of Texas JACKBIGBTOWER FirstAssistantAttorney General

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MARYKELLER ExecutiveAssistantAttorney General JUDGE ZOLLIE STEAKLEY SpecialAssistant Attorney General
RICK GILPIN Chairman,OpinionCommittee Preparedby Nancy Sutton AssistantAttorney General

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