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DAN MORALES .ATTORSEY GENERAL 

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March 21, 1996

The Honorable Patrick J.Fleming Parker County Attorney One Courthouse Square Weather-ford, Texas 76086 Opinion No. DM-380

Re: Whether the Parker County Hospital District is responsible for the payment of health care costs for inmates in the Parker County Jail who are “eligible residents” of the hospital district under chapter 61 of the Health and Safety Code and related questions (RQ-863)
Dear Mr. Fleming:
You ask several questions concerning the origin of payment for health care assistance of inmates of the Parker County Jail. Specificahy, you ask whether, in particular situations, the district, the jail, or some other entity is responsible for the payment of health care costs of countyjail inmates. We assume you do not inquire about prisoners held for another jurisdiction pursuant to a contract between Parker County and the other jurisdiction. We will begin our analysis by examining statutes pertinent to the Parker County Hospital District (the “hospital district”).

“Pursuant to the authority granted by the provisions of Section 9 of Article JX of the Constitution of the State of Texas,” the legislature authorized the creation of the hospital district in 1965. See Act of March 10, 1965, 59th Leg., RS., ch. 35, 3 1, 1965 Tex. Gen. Laws 93, 93,amenakdby Act ofMay 28, 1975, 64th Leg., R.S., ch. 444, tj 1, 1975 Tex. Gen. Laws 1186, 1187; Act of May 31, 1981.67th Leg., RX, ch. 472, 1981 Tex. Gen. Laws 2081,2081-82; Act ofApril 27, 1989,71st Leg., RS., ch. 66, 1989Tex. Oen. Laws 378, 378-80; Act of May 25, 1991, 72d Leg., R.S., ch. 705, $37, 1991 Tex. Cien.Laws 2520,2529. Section 1ofthe hospital district’s enabling legislation establishes the hospital district’s boundaries ascoextensive with the boundaries ofParker County and provides the hospital district “such rights, powers and duties as” the enabling act prescribes. Act ofMarch 10, 1965,59th Leg., R.S., ch. 35, 5 1, 1965Tex. Gen. Laws 93, 93.
The enabling act establishes as one of the hospital district’s duties “‘full responsibility for providing medical and hospital care for needy inhabitants

.” ofthe hospital district. Id. 92, at 94; see aZsoHealth & Safety Code $286.082(a) (requiring hospital district created by voter approval to provide, without charge, care and treatment ofindigent patient). Moreover, section 20 ofthe enabling legislation provides asfollows:

After creation of the hospital district, neither Parker County, Texas, nor any city or town therein shall thereafter issue bonds orThe Honorable Patrick J.Pleming - Page 2 (DM-380)

other evidences ofindebtedness for.

. .medical treatment of indigent persons within such boundaries, nor shag such political subdivisions levy taxes for.

. . such purposes. The said hospital district shah
assume fbh responaibiity for the operation ofallhospital facilities for the tinnishing ofmedical and hospital care of indigent persons within itsboundaries.
Act ofMarch 10,1965,69th Leg., RS., ch. 35, 520, 1965Tex. Gen. Laws 93,99.
The hospital district’s enabling act mirrors article IX., section 9 of the Texas Constitution, which authorizes the legislature to provide for the creation of hospital dis&ictssolongas”anydiatrictsocreated... assume[s] 111responsibiity for providing medical and hospital care for its needy inhabiis.” After the creation of a hospital district, article Iy section 9 states, “no other municipality or political subdivision shag have the power to levy taxes or issuebonds or other obligations.

. .for providing medical
care within the boundaries ofthe district.”

In addition to the hospital district’s enabling act and article IX, section 9 of the constitution, two statutes are &vant to your questions: the Indigent Health Care and Treatment Act, Health and Safety Code chapter 61. and Code of Criminal Procedure article 104.002. Chapter 61 of the Health and Safbty Code pertains to the provision of medical care.to “eligible” individuals, i.e., individuals who meet the income and resources requirements established by or in accordance with chapter 61. Health & Safety Code 561.002(4). A hospital district must provide to a resident of the hospital district the he&h care services required under the Texas Constitution and the hospital district’s enablingact. Id. 561.055. (Siiarly, section 286.082 of the Health and Safety Code requires ahospital district created byvoter approval to provide, without charge, necessary medical care and treatment to an indigent patient. See Act of March 10,1%5,59th Leg., RS., ch. 35,s 3, 1965Tex. Gen. Laws 93.94).
With regard to an eligible individual who does not reside within the service area of
ahospital district, a county isresponsible for the provision ofhealth care assistance to the individual ifthe individual resides within the county and has no other adequate source of payment. Health & Safety Code 461.023(a); see ah id. 561.022 (requiring county to provide health care assistance to eligible county residents). A county may, however, establish alessrestrictive standard ofeligibility. Id. 061.023(b). Thus, whether a hospital district or a county bears the cost of an eligible individual’s health care assistance depends primarily on the individual’s place ofresidence.

“[A] person ispresumed to be aresident ofthe govemmentaJ entity inwhich the person’s home or fixed place of habitation to which the person intends to return after a temporary absence is located.

. . . [Jlf a person’s home or 6xed place of habitation is located in a hospital district, the person is presumed to be a resident of that hospital district.” Id. 561.003(a). The Department of He&h is the arbiter of any disputes between a provider of assistance and a governmental entity or hospital district regarding an individual’s residence. Id. §61.004(a).

p. 2065The Honorable Patrick J.Fleming - Page 3 (DM-380)

Article 104.002 of the Code of Criminal Procedure specifically per&s to the provision of medical, dental, or health-related services to prisoners confined in a county jail. (a) Except as otherwise provided by this article, a county is

liable for all expenses incurred in the safekeepii of prisoners confinedinthewuntyjailorkeptundaguardbythccounty..

. . (b) Ifacounty incurs eqenses for the safekeeping ofaprisoner from another county, the shetifFshall submit to the county judge an account of acpmses incurred by the county for the prisoner. The county judge shall approve the amount he determines is a correct statement ofthe expend and sign and date the account. (c) The countyjudge shall submitto the wmmissioners court of the wunty for which the prisoner was kept, at a regular term of the court, his signed statement of the account described by Subsection (b). If the wmmissione-rs court determines that the account is in accordance with the law, it shall order the county treasurer to issue to the she-r8 of the wunty submitting the statement a drag in an amount approved bythe court. (d) A person who is or was a prisoner in a county jail and received medical, dental, or health related services from acounty or a hospital district shallbe required to pay for such services when they
are rendered. If such prisoner is an eligible county resident as de&ted in Section 61.002, Health and Safety Code, the county or hospital district providing the services has a right of subrogation to the prisoner’s right of recovery from any source, limited to the cost of WV&S provided. A prisoner, unless the prisoner tidly pays for the cost of services received, shallremain obligated to reimburse the wunty 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 Safkty Code. A wunty or hospital district shall have authority to recover the amount expended in acivil action.1 [Footnote added.]
In Attorney General Opiion DM-225 this office considered whether the Kames County Jail or the Kames County Hospital District is liable for the costs of health care assistance rendered to inmates of the Kames County Jail who are eligible for such assistance under chapter 61 of the Health and Safety Code. Attorney General Opinion

‘SeeActofApril25,1995,74th Leg.,RS., ch.76,§ 3.22, 1995Tar.Ses LawServ.458,469.

p. 2066The Honorable Patrick J.Pleming - Page 4 (DM-380)

DM-225 (1993) at 1. The opinion 6rst addresses the responsibiity of the Kames County Hospital District for eligible individuals who reside inthe hospital district:

[Slection 61.055 of the Indigent Health Care and Treatment Act

. provides that a hospital district must provide the health care services and treatment required by the wnstitution and the district’s enabling legislation.

. . . [Tlhe Karnes County Hospital District has been created in Kmnes County and is coextensive with the county.

. The district’s enabling act and the wnstitution require the district to provide medical care for its needy residents

. . . . Prior opinions of this office have wnsistently 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 Cienet-alOpiions lM-643 (1987); I’M-487 (1986); H-703 (1975). Thus, it is our opinion that the Kames County Hospital District isresponsible for the medical costs of an indigentjail inmate who isaresident ofthat district. Id.

The opinion next determines that, for an eligible inmate residing in another hospital district or the service area of a public hospital,s that hospital district or public hospital is liable for the costs ofhealth care assistance rendered to the inmate. Id. at2. The opinion expressly does notconsider, however, the responsibility of costs for health care assistance rendered to inmates who arenot residents ofTexas. Id.at3.

The opinion finally contemplates an indigent inmate ofthe Kames County Jailwho does not reside inKames County, nor within any hospital district or public hospital service
area. Id. at 2. Construing section 61.022 of the Health and Safety Code together with article 104.002(d) of the Code of Criminal Procedure, the opinion determines that the inmate’s county of residence is ultimately responsible for the costs of health care assistance provided to such an inmate. Id.at3.

(1) thebasicirComcandlraommarcquiromentscstahliihythc~cws Dqytmmt ofHealth]mtder Sections61.006and61.008andineffectwhenthe assrstancc

isrqxstcd; or (2)a less restrib income and --adoptcdbyti hospitalservingtheamainwhichthepaxonES&S.
Id. 861.052(a).

p. 2067The Honorable Patrick J.Fleming - Page 5 (DM-380)

Attorney General Opiion DM-225 resolves some ofyour questions. You tirst ask whether the hospital district or the county is responsible for the payment of health care costs, “including outpatient and inpatient care, dental care and pharmacmtical wstq” for indigent prisoners inthe Parker County Jailwho are residents ofParker County. Because the boundaries of the hospital district are coextensive with Parker County, a resident of the county is a resident of the hospital district. Under the hospital district’s enabling act, the hospital district must assume.“thll responsibiity for providing medical and hospital
care for its needy inhabitants

. . . .” Act ofMarch 10, 1965, 69th Leg., RS.. ch. 35, 82, 1965 Tex. Gen. Laws 93, 94; see a%0 Tar. Const. art. IX, 89. The hospital district’s duties extend to its eligible residents housed in the county jail. See Attorney General Opiion DM-225 (1993) at 1. Accordingly, the hospital district either must provide such imnates necessary medical and hospital care or recompense the providers ofthe care.’ See Act of March 10, 1%5, 69th Leg., RS., ch. 35, 52, 1%5 Tex. Gut. Laws 93. 93-94; Health & Safety Code 4861.055,286.082(a); Attorney General Opiion DM-225 (1993) at 1.

Whether the “medical and hospital care” the hospital district must provide includes outpatient and inpatient care, dental care, and pharmaceutical costs is a matter left to the discretion of the hospital district’s governing body. Attorney General Opiion DM-37 (1991) at 5(quoting Attorney General Opiion JM-1052 (1989) at 4).

Certainly, the Texas Constitution and statutory law require hospital districts to provide at least essential medical services to their indigent residents. Whether ahospital district mustprovide a specific service., however, is a matter that the legislature has chosen by default’ to leave to the governing body ofahospital district. Id. (footnote added).

You ask whether the hospital district or Parker County is responsible for the payment of health care costs incurred by an eligible inmate ofthe Parker County Jail who resides in another county. As we determined in Attorney General Opiion DM-225, the inmate’s county of residence is ultimately responsible for the wsts of health care assistance provided to the inmate ifthe inmate resides outside the bounds of a hospital district or public hospital service area. Attorney General Opiion DM-225 (1993) at 3.

p. 2068The Honorable Patrick J.Fleming - Page 6 (DM-380)

Lilrewise, if the eiigible inmate resides in another hospital district, the inmate’s home hospital district is liable to the Parker County HospitaJ District for all health care services the hOmehospital district is required to provide, as well as additional services the home hospital district regulady provides. If,ontheotherhand,theinmateresideswithintbeeaviceareaofapublichospitrZ
we believe the Parker County HospitaJ District must look to two entities fbr rehbumme-nt. A public hospital is required to provide only inpatient and outpatient hospital services. See Health & Safety Code 0561.028(a)(l), .054(a). Thus, the inmate’s home public hospital is liable to the Parker County Hospital District only for the cost of such setvices rendered to the inmate. The public hospital may be liable for other health
care servica if it mgtdarly provides such setvices to its eligible residents. See id §61.054(b), (c). The county ofthe eligible inmate’s residence is liable for all health care costs not covered by the public hospital (assuming the county is required to provide such setvices under section 61.028(a) ofthe Health and Safety Code or regularly provides such services under section 61.028(b)).

The-statutesdo not indicatehow aprovider of health care assistance is to receive reimbursanent ikom the governmental entity that is ultimately gable for an eligible inmate’s health care costs. If the hospital district provides health care services to an eligible imnate of the Parker County Jail who resides in another wunty, hospital district,
or public hospital service area, we believe the hospital district may bill the governmental entity or entities that is ultimately liable for the wsts. Because you do not inquire as to the propriety ofany other methods, we do not address other possible methods.

You ask whether the hospital district or Parker County is responsible for the payment of all health care costs of an eligible prisoner in the wunty jail who resides in another state.5 As we mentioned, Attorney General Opinion DM-225 expressly mserves this question. Under article 104.002(d) of the Code of Criminal Procedure, the hospital district must require an inmate to pay for medical, dental, or health related services at the time the serviws are rendered. If, however, the inmate is “an eligible county resident as de&ted in Section 61.002, Health and Safety Code,” the hospital district has a right of subrogation to the prisoner’s right of recovery from any source. Code Crim. Proc. art. 104.002(d). The hospital district may apply for reimbursement aspermitted byHealth and Safety Code chapter 61, the Jndigent Health Care and Treatment Act.

We believe chapter 61 ofthe Health and Safety Code pertains only to the costs of medical treatment for Texas residents. Nothing in chapter 61 appears to contemplate an indigent resident of another state. For example, section 61.003(a) of the Health and Safbty Code presumes a person to reside in “the governmental entity” in which the
~You¬~~wc¬,thcnforr,EohFida,wwhichcntityisLiaMcforthcEostsofhcaltb cerr~rradendmweligiMeinmatcwhoisaeili+cn~aoothcrcarntry. ButseeAttomy Gcwml Opiioo JM-1021(1989)at4-5 (sqgcsting tbatIndigentHealthCaread Treatmat Actdog notexcludeillcpl immigrants fromcoverage

iftbcymeetmidauq andeligibilityrapircmnt).

p. 2069The Honorable Patrick J.Pleming - Page 7 (DM-380)

person’s home is located. “Governmental entity” is defined to include a county, municipality, or other political subdivision of the me. In addition, section 61.002(4) requires the Department of Human Services to mandate that every applicant for health
care inform the department of, among other things, the applicant’s “wunty of residence.” Nothing in section 61.007 requires the Department of Human Services to obtain information regarding the applicant’s state ofresidence. Ifthe legislature had considered that an indigent applicant maybei?om another state, webelieve the legislature would have provided in these two sections, or elsewhere, for a county, hospital district, and public hospital to determine the applicant’s state of residence. Accordingly, we believe article 104.002(d) of the. Code of CriminaJ Procedure provides a hospital district a right of subrogation to an inmate’s right of reimbumemem only when the inmate is an eligible resident of Texas. When an indigent inmate resides in another state, section 104.002(d) permits ahospitaJ district to seekreimbursement only from the inmate.

You ask whether the hospital district may establish an indigent he&h care policy that provides fewer medical services than the amount of medical services an indigent prisoner isentitled to under federal or state laws. Under section 61.055 ofthe Health and Safety Code, the hospital district must provide all health care services required under the Texas Constitution and the hospital district’s enabling act. As we stated above, the hospital district must provide, at the least, ail essential medical services to its eligible residents. See Attorney General Opinion DM-37 (1991) at 5 (quoting JM-1052 (1989) at 4); supra p. 5. E, asyou suggest, federal Jawindeed requires ahospital district to provide additional medical services, the hospital district must provide such services.6 Whether a hospital district must provide any other, nonrequired services is within the discretion of the hospital district’s governing body. See Attorney General Opiion DM-37 (1991) at 5 (quoting JM-1052 (1989) at4); suprap. 5.

In arelated vein, you ask whether the hospital district may “establish an application for indigent health care that requests so much information that it is impossible for an inmate to complete the. application in order to be considered for indigent health care setviws.” You also ask who determines an inmate’s eligibility to receive health care assistance under chapter 61 of the Health and Safety Code, and whether the decision maker may “do so in such afashion that deprives the imnate ofhealth care as required by law.” Wewill answer these questions together.

The hospital district makes the determination as to whether a particular applicant for health care assistance is eligible for such assistance. Section 286.082(b) of the Health and Safq Code requires a hospital district annuahy to adopt an application procedure to determine eligibility for assistance. See ah Health & Safety Code 361.053(a) (requiring hospital district to adopt application procedure). Section 286.082(c) authorizes the hospital district administrator to “have an inquiry made into the financial circumsmnces of

p. 2070The Honorable Patrick J.Pleming - Page 8 (DM-380)

the applicant patient and a relative of the patient who is legally responsible for the patient’s support. See alsoAct of March 10, 1965, 59th Leg., RS., ch. 35, 5 18, 1%5 Tar. Cert. Laws 93, 99 (requiring administrator of hospital district to inquire into chmstanccs ofpatient residing within hospital district). Although a hospital district need not comply with the eligibiity standards and application, documentation, and verification procedures the Department of Health has adopted pursuant to section 61.006 of the Health and Safety Code, the hospital district may use the standards and procedures as guidance in developing its own standards and procedures. See Attorney General Opiion JM-858 (1988) at 3; see aLF0supra note 4 (descrii adoption of Texas Constitution article IX, section 9A). The.hospital district alsomryrefertothelistofinformation~~pti~fOTIISSi~fiomacOuntymust provide. SeeHealth & Safes Code 861.007;740 T.A.C. $15607(c).

A hospital district may not adopt eligibility standards or application procedures that are inconsistent with its enabling act. Moreover, we do not believe a hospital district may establish standads or procedures that ckumvent the hospital district’s wnstitutional duty to provide “medical and hospital care for its needy inhabitants.” See Tex. Const. art. IX, 89. Whethex pticular standards or procedures circumvent a hospital district’s wnstuutional duty is a question involving the resolution of fact issues; such a question is inappropriate to the opinion process. See, e.g., Attorney General Opinions DM-98 (1992) at 3,H-56 (1973) at 3,M-187 (1%8) at 3,0-2911 (1940) at 2.

You ask which govemnmtal entity isresponsible for medical costs incurred by an indigent inmate in the county jail who is a state prisoner. Article 104.002 ofthe Code of Criminal Prowdure refbrs only to a prisoner in a county jail, without distinguishing

(1) theapplicant’s

ml nameandaddmsq (2) theappIicaat’6

SociaI swmi@mmlbcr,

ifavailable; (3) tknumherdpusoastnthsappIka&heaseheId,exclexdudingpersmu raxiviq AFDC,SSI,orI&&aid bandits; (4) tkapp~sanmlyof-; (5) tbeexistwwofiosmwwmwycorahcrborpitiM~~- berdts forwhichtk applicant iseligible; (6) aaylmasferdtitIetcmaIpmpntylbattka@icaathasmadeIathc prowding24monIb& (7) theappIiwnt’sammalbus&old income, eacI* theinanneefaay bouschold

member tuxiviq AFDC,SSI,erMedicaid bet&S: aad (8) theamountofthcapplicant,sLiquidrpEas~tbeequityvalucdtbe appIicanI’s

carandmalpropmy.

p. 2071The Honorable Patrick J.Fleming - Page 9 (DM-380)

between those prisoners who are prisoners of the wunty or prisoners of the state. See Attorney General Opiions JM-730 (1987) at 2, Jh4-743 (1987) at 2. Furthermore, we find no statute that expressly encumbers the state with the responsibiity of medical care for state prisoners housed in county jails. See Gov’t Code $493.001; cfl Attorney General Opiion JM-743 (1987) at 2 (wnstndng statutory predecessor to Gov’t Code 5493.001, men&dby Act of March 25, 1991, 72d Leg., RS.. ch. 16. 8 10.01(a). 1991 Tex. Gen. Laws 244, 274). Consequently, if the hospital district renders health care asaktance to an eligible state prisoner housed inthe countyjail, the hospital district ispaid for the services in accordance with article 104.002(d) of the Code of Criminal Procedure and chapter 61 ofthe Health and Safety Code.

You a& whether Parker County may levy and wllect taxes for the costs of medical care for eligible prisoners inthe Parker County Jail. Aswe have stated above, the hospital district’s enabrmgact prohibits the county from issuing “bonds or other evidences of indebtedness for. medical treatment of indigent persons within [the] boundaries” of the hospital district, see Act ofMarch 10, 1%5,69th keg., R.S., ch. 35, 520, 1%5 Tex. Gen. Laws 93,99; inaddition, the.enabling act prohibits the county from levying taxes for such purposes, id Furthermore, article JX, section 9 of the Texas Constitution deprives any other political subdivision, including a county, of wle power to levy taxes or issue bonds or other obligations

. for providing medical care within the boundaries of the district.” Tex. Const. art. JX, §9.

The hospital district’s responsibiity to provide medical and hospital care extends only to residents of the hospital district. See Tex. Const. art. JX, 59; Health & Safety Code $61.055; Act ofMarch 10, 1965, 69th Leg., RS., ch. 35, $20, 1965 Tar. Gen. Laws 93, 99. Thus, neither the enabling act nor article JX, section 9 of the Texas Constitution precludes Parker County from raising revenue, through the wllection of taxes, to pay medical costs of eligible inmates who are not residents of the hospital district.* But see Tex. Const. art. VI& 33 (mandating that taxes shag be levied and

*Acotmtymaylevytaxesonlyinammian~ tilhtheamybodgu. .%eLccalGov’tcIxk 8 111.010(a). Section111.OlOofthcLocalGovmmeot Codeappliesonlytoacotmty withapopulation oT225,oooor1tssthatQcsnotopaatcundcrchapa111,subchapercoftheLocalGovernmmtcodc. LocalGov’tC&~111.001. Acarntywithapopllationgnatcrthan125.000maychowctocpaatc mxler snhcbapter

C. Id. 5111.061. ParkerComtty hasapopulationof64,785. U.S. Dcpartmntof

**-, 15** **’ 5** **’ 0**  **thWJS OF**  **POpULATION:** G- **POPULATION** cltARACTERISllCS: 'fEXAS 3 (1%)). Thos,hkerthnymnstoperateinacaMkwe with chapter111. dchaptu A, of which section 111.010isapart.

p. 2072The Honorable Patrick J.Fleming - Page 10 (DM-380)

wkted for pub;:: purposes only); seeah id. art. IJJ. 852(a) (Prohibiting expenditure of public lunds for nonpublic purposes).

We question the necessity of raising revenues to cover the costs of providing health care assistance to countyjail inmates who do not reside inParker County, however, because subsection (d) of article 104.002 of the Code of Criminal Procedure appears to abv the provider of medical se&es to recoup its costs. See Hearings on H.B. 2308 Before the House Comm. on County AlGim, 70th Leg. (Apr. 7.1987) (statement of Dan Smith, Beg County Sheriff) (tape available from House Video/Audio !&&es Oflice) (stating that House Bii 2308, which became article 104.002(d) when enacted, provided various methods 6om mrmbmxment of medical costs counties pay for county jail itUtUS).

You finally ask what retnedies may be taken against the hospital district or its board, either as awhole or as separate individuals, ifthe hospital district failsto cany out its wdtutional and statutory duty to provide “medical and hospital care for its needy inhabitants.“s Tex. Const. art. IX, 89; Act of March 10, 1%5,69th Leg., RS., ch. 35, 82,1%5 Tex. Gen. Laws 93,93-94. You listmandamus, criminal prosecution for official miawnduct, removal from office, andjoining the hospital district in acivil rights action for fiihtre to provide adequate health care.to eligible imnates. Whether a particular remedy is available or appropriate depends on the facts of the particular situation. The issue is, therefore, fact-based and inappropriate to the opinion process. E.g., Attomey General Opiions DM-98 (1992) at 3,H-56 (1973) at 3,M-187 (1968) at 3.0-2911 (1940) at 2.

SUMMARY
Tbe Parker County Hospital District must provide necessaq medical and hospital care to inmates of the county jail who reside in Parker County. In the alternative, the hospital district may reimburse the providers of such care. Whether the medical and hospital care the hospital district must provide includes outpatient and inpatient care, dental care, and pharmaceutical coats is a matter letI to the discretion of the governing body of the Parker County Hospital District, except that the hospital district may not provide fewer servicu than required bylaw.

With respect to **M** inmate ofthe Parker County Jail who resides in another county, outside the boundaries of ahospital district or the service area of a public hospital and who is eligible for health care assistant under chapter 61 of the Health and Safety Code, the
pYoualsoaskwhcthcr.iflbchc6pitaldistrbbsnmdcmdmcdical smiwatoapriwwrwhois ~~~leundnchapta61tbeHcalthendsaf*ycode,~~bospitaldistriaEbarldraLpaymmtfrom thatprisonerorthecoomy. WehavepmdiagMore as woUwsopiniontequcs& number RQ-685,that cams&rsmldwill answwthatqnestion.

p. 2073TheHonorablePatrick J.Fleming - Page 11 (DM-380)

inmate’s county of residence is responsible for the costs of health
cm assistance provided to the inmate. If the inmate resides within the boundaries of another hospital district, that hospital district is responsible to the Parker County Hospital District for the costs of any health care services the. home hospital district is required to provide, as well as any additional services the home hospital district regularly provides. Jfthe inmate resides within the service area of a public hospital, the public hospital must reimburse.the Parker County Hospital District for the costs of inpatient and outpatient hospital services provided to an eligible inmate of the Parker County Jail, as well as the costs of any other health care amistance the home public hospital reguMy provides. Oenerally, the inmate’s wunty of residence is responsible for the remaining costs of health care assistMce.

If the Parker County Hospital District provides health care assistance to an inmate in the Parker County Jail who is eligible for assistance under chapter 61 of the Health and Safety Code and who resides in another county, hospital district, or the service area of a public hospital, the hospital district may bii the govemmental entity
or entities that isultimately liableforthe costs.

An indigent inmate who resides in another state is ultimately liable for the costs ofthe medical services he or she has enjoyed. A hospital district may not subrogate itself to the right of an eligible inmate to reimbursement ifthe inmate resides outside the state.
The Parker County Hospital District must provide to **M** eligible imnate of the Parker County Jail who is aresident of Parker County all essential medical care. The hospital district also must provide all health care assistance the federal lawrequires itto provide. Whether
a hospital district provides other services is within the discretion of the hospital district’s governing body.

In developing its own eligibility standards and application, documentation, and verilication procedures, a hospital district may refer for guidance to the standards and application, documentation, and verification procedures the Department of Health has adopted pursuant to Health and Safety Code section 61.006. The hospital disttict also may refer for guidance to the list of information an applicant for health care assistance from a county must provide, pursuant to Health and Safety Code section 61.007. A hospital district may not adopt eligibility standards or application, documentation, and verification procedures inwnsistent with its enabrmg act, nor may a hospital district establish standards and

p. 2074The Honorable Patrick J.Fleming - Page 12 ~-380)

proceduresthat ciraunvent the hospital district’s wnstitutional duty under title IX, section 9ofthe Texas Constitution.

If a hospital district renders health care aa&ance to **M** eligible state prisoner housed in the county jail, the hospital district is paid for the services in accordance with Code of Criminal Procedum article 104002(d) andHealth and Safbty Code chap&r 61.

A county may levy taxes for medical wsts incurred by eligible inmatesofthewuntyjailwhoresideinanothawuntyifthetwisin accordance with the county budget. The wunty wmmissioners court must determine that the imposition of the tax for this purpose serves apublic purpose.
Whether a particular cause of action is available or appropriate to protest a hospital district goveming board’s dereliction of duties depends upon the facts ofthe situation.

DAN MORALES Attorney General ofTexas
JORGE VEGA Fii Assistant Attorney Gene-ral

SARAH J. SHJRLEY Chair, Opiion Committee Prepared by Kymberiy K. Oltrogge Assistant Attorney General

p. 2075