October 10, 1989 

Honorable Gary W. Rholes 

Shelby County Attorney 

104 Church Street 

Center, Texas 75935 

Opinion No. JM-1108 

Re: Whether a county that has 

closed a public hospital may 

change its eligibility standards for indigent health care 

applicants (RQ-1669) 

Dear Mr. Rholes: 

You ask the following question about the Indigent 

Health Care and Treatment Act: 

Can a county that has closed a public 

hospital avail itself of Section 13.02 of the 

Indigent Health Care and Treatment Act to 

change its eligibility standards for 

applicants for indigent health care? 

Under the Indigent Health Care and Treatment Act, 

Health & Safety Code ch. 61,l a public hospital must provide 

certain health care services to eligible residents of the 

area the public hospital has a legal obligation to serve. A 

county hospital is a public hospital.2 Therefore, a county 

1. The Indigent Health Care and Treatment Act was 

previously codified as article 4438f, V.T.C.S. It has now 

been recodified as chapter 61 of the Health and Safety Code. 

Acts 1989, 71st Leg., ch. 678, 5 1, at 2292. 

2. The act defines "public hospital" as "a hospital 

owned, operated, or leased by a governmental entity." 

Health & Safety Code § 61.002(U); see also Acts 1989, 71st 

Leg., ch. 500, § 1, at 1685 (amending definition of "public 

hospital"). A "governmental entity" includes 'Ia county, 

municipality, or other political subdivision of the state, 

but does not include a hospital district or hospital 

authority." Health & Safety Code 5 61.002(7). 

P. 5804 
Honorable Gary W. Pholes - Page 2 (JM-1108 ) 

,that has a public hospital is subject to the provisions of 

the act governing public hospitals rather than the 

provisions governing counties.3 See aem Health & 

Safety Code 5 61.023 (eligibility standards for counties). 

Section 61.052 of the act governs eligibility standards 

for public hospitals. In short, section 61.052 provides 

that a public hospital must adopt eligibility standards that 

are at least no more restrictive than the standards 

established by the Department of Health under section 61.006 

of the act. If, in the operating year that ended before 

January 1, 1985, the hospital used less restrictive 

standards than those established by the Department of 

Health, the hospital must retain those standards. A public 

hospital may change its eligibility standards to make them 

more restrictive4 only if it complies with the rather 

burdensome requirements of section 61.063, which provides: 

(a) A public hospital may not change its 

eligibility standards to make the standards 

more restrictive and may not reduce the 

health care services it offers unless it 

complies with the requirements of this 

section. 

(b) Not later than the 90th day before the 

date on which a change would take effect, the 

public hospital must publish notice of the 

proposed change in a newspaper of general 

circulation in the hospital's service area 

and set a date for a public hearing on the 

change. The published notice must include 

3. The services a public hospital is required to 

provide are not the same as the services a county is 

required to provide. &S Health & Safety Code §§ 61.028, 

61.054.. 

4. When all the provisions of the Indigent Health Care 

and Treatment Act are read together, it is evident that a 

public hospital cannot use the procedures set out in section 

61.063 to make its standards more restrictive than those 

established by the Department of Health. See. e.a., Health 

& Safety Code 5 61.052(e) (providing that if the Department 

of Health makes its eligibility standards less. restrictive, 

the public hospital must change its standards to at least 

comply with the department's standards). 

P. 5805 
Honorable Gary W. Rholes - Page 3 (JM-1108) 

the date, time, and place of the public 

meeting. The notice is in addition to the 

notice required by the open meetings law, 

Chapter 271, Acts of the 60th Legislature, 

Regular Session, 1967 (Article 6252-17, 

Vernon's Texas Civil Statutes). 

(c) Not later than the 30th day before the 

date on which the change would take effect, 

the public hospital must conduct a public 

meeting to discuss the change. The meeting 

must be held at a convenient time in a 

convenient location in the hospital's service 

area. Members of the public may testify at 

the meeting. 

(d) If, based on the public testimony and 

on other relevant information, the governing 

body of the hospital finds that the change 

would not have a detrimental effect on access 

to health care for the residents the hospital 

serves, the hospital may adopt the change. 

That finding must be formally adopted. 

Health & Safety Code 8 61.063. 

A county that closes its- public hospital is subject to 

the following provision: 

Sec. 61.064. TRANSFER OF A PUBLIC 

HOSPITAL. (a) A governmental entity that 

owns, operates, or leases a public hospital 

and that closes, sells or leases the 

hospital: 

(1) has the obligation to provide 

mandatory health care assistance under 

this chapter; 

(2) shall adopt the eligibility 

standards that the hospital was or would 

have been required to adopt: and 

(3) shall provide the same services the 

hospital was or would have been required 

to provide under this chapter on the date 

of the closing, sale, or lease. 

Health & Safety Code § 61.064. 

P. 5806 
Honorable Gary W. Pholes - Page 4 (JM-1108) 

your question is whether a county that has closed its 

public hospital and is thus subject to section 61.064 may 

avail itself of the provisions of section 61.063 to make its 

eligibility standards more restrictive. Your question 

requires us to determine the combined effect of section 

61.063 and section 61.064. Section 61.064 requires a county 

that closes its hospital to adopt the eligibility standards 

that the county hospital would have been required to adopt. 

We interpret that language to mean that a county that closes 

its hospital will continue to be governed by the eligibility 

requirements applicable to public hospitals rather than the 

requirements applicable to counties. We do not interpret it 

to mean that a county that closes its county hospital must 

adopt eligibility standards that are fixed for all time. 

Because section 61.063 is a provision governing eligibility 

standards for public hospitals, a county that has closed its 

county hospital may avail 

section 61.063.5 

itself of the provisions of 

SUMMARY 

A county that closes its county 

hospital may avail itself of the provisions 

of section 61.063 of the Indigent Health Care 

and Treatment Act, Health and Safety Code, 

chapter 61. 

Very truly yo J A;, hLa7c 

JIM MATTOX 

Attorney General of Texas 

5. Although you ask about making eligibility standards 

more restrictive, we note that a public hospital may make 

its eligibility standards less restrictive at any time. 

Health & Safety Code 8 61.052(d). Section 61.063 applies 

only when a public hospital wishes to make its eligibility 

standards more restrictive. 

P. 5807 
Honorable Gary W. Rholes - Page 5 (JM-1108) 

NARYXELJJ3R 

First Assistant Attorney General 

Lou MCCREARY 

Executive Assistant Attorney General 

JUDGE ZOLLIE STEXKLEY 

Special Assistant Attorney General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by Sarah Woelk 

Adsistant Attorney General 

p. 5808