THE ATTORNEY GENERAL. 

OF TEXAS 

February 24, 1989 

Honorable Benjamin Euresti, Jr. Opinion No. JM-1021 

Cameron County Attorney 

Cameron County Courthouse 

974 E. Harrison Street 

Brownsville, Texas 78520 

Re: Whether a county may 

condition receipt of 

assistance under the 

Indigent Health Care Act 

on an applicant's furnishing a social security 

number (RQ-1539) 

Dear Mr. Euresti: 

You ask whether a county may deny assistance under the 

Indigent Health Care and Treatment Act, article 

V.T.C.S.., if an 

4438f, 

applicant does not have a social 

number. 

security 

It has been suggested that federal law would not permit 

a political subdivision to deny health-care benefits because 

of an applicant's failure to provide a social 

number. Section 

security 

7 of the federal 

provides: 

Privacy Act of 1974 

(a)(l) It shall be unlawful for any 

Federal, State or.local government agency to 

deny to any individual any right, benefit, or 

privilege provided by law because of such 

individual's refusal to disclose his social 

security account number. 

(2) the provisions of paragraph (1) of 

this subsection shall not apply with respect 

to -- 

(A) any disclosure which is required 

by Federal statute, or 

(8) the disclosure of a social 

security number to any Federal, State, 

or local agency maintaining a system of 

records in existence and operating 

p. 5267 
Honorable Benjamin Euresti, Jr. - Page 2 (JM-1021) 

before January 1, 1975, if such 

disclosure was required under statute 

or regulation adopted prior to such 

date to verify the identity of an 

individual. 

(b) Any Federal, State, or locai government agency which requests an individual to 

disclose his social security account number 

shall inform that individual whether that 

disclosure is mandatory or voluntary, by what 

statutory or other authority such number is 

solicited, and what uses will be made of it. 

Public Law 93-579, 5 7 (reprinted at 5 U.S.C. 5 552a, note). 

A 1976 amendment to the Social Security Act, however, made 

an additional exception to the prohibition set out in 

section 7(a)(l) of the federal Privacy Act: 

(i) It is the policy of the United States 

that any State (or political subdivision 

thereof) may, in the administration of any 

tax, general public assistance, driver's 

license, or motor vehicle registration law 

within its jurisdiction, utilize the social 

security account numbers issued by the 

Secretary for the purpose of establishing the 

identification of individuals affected by 

such law, and may require any individual who 

is or appears to be so affected to furnish to 

such State (or political subdivision thereof) 

or any agency thereof having administrative 

responsibility for the law involved, the 

social security account number (or numbers, 

if he has more than one such number) issued 

to him by the Secretary. 

. . . . 

(iii) For purposes of clause (i) of this 

subparagraph, an agency of a State (or 

political subdivision thereof) charged with 

the administration of any general public 

assistance, driver's license, 

vehicle registration law which dizrnot 

motor 

use 

the social security account number for 

identification under a law or regulation 

adopted before January 1, 1975, may require 

an individual to,disclose his or her social 

security number to such agency solely for the 
Honorable Benjamin Euresti, Jr. - Page 3 (JM-1021) 

purpose of administering the laws referred to 

in clause (i) above. 

42 U.S.C. 5 405(c)(2)(C)(i) and (iii)(emphasis added). See 

generallv Dovle v. Wilson, 529 F.Supp. 1343 (D. Del. 1982). 

Although we find no cases that construe the term "general 

public assistance," we think that an indigent health-care 

program would come within that category. Therefore, the 

federal Privacy Act would not prohibit a state or political 

subdivision from requiring an applicant to disclose his 

social security number. 

We do not, however, interpret the Indigent Health Care 

and Treatment Act as making assistance contingent on the 

provision of a social security number. That act requires a 

county to provide health care to indigent residents of the 

county who are not residents of the area a hospital district 

or public hospital has an obligation to serve. V.T.C.S. 

art. 4438f, 8 2.02. The Department of Human Resources is 

required to establish eligibility standards and application, 

documentation, and verification, procedures for counties to 

use in determining eligibility under the act. Id. 

§ 1.06(a). The rules of the Department of Human Resources 

relating to the application and documentation procedures 

must require each applicant to provide certain information 

including "the applicant's social security number, if 

available." Id. 5 1.06(c)(2). We think the phrase II if 

available" makes clear that an applicant who does not have a 

social security number is not required to provide one in 

order to receive assistance under the Indigent Health Care 

and Treatment Act.1 

You suggest, however,. that a county must condition 

assistance on the receipt of a social security number 

because the act "indicat[es] that the Indigent Health Care 

program is to follow standards and procedures used to 

determine eligibility in the AFDC-Medicaid program." YOU 

then argue that because federal law requires applicants for 

AFDC to provide social security numbers, see 42 U.S.C. 

§§ 602(a)(25); 1320b-7, applicants for assistance under the 

1. Your letter indicates that you are concerned about 

individuals who have no social security number rather than 

individuals who have a social security number but refuse to 

provide it. Therefore, we consider the meaning of the 

phrase "if available" only in the context of individuals who 

do not have social security numbers. 

P. 5269 
Honorable Benjamin Euresti, Jr. - Page 4 (JM-1021) 

Indigent Health Care and Treatment Act must be required to 

provide social security numbers. 

We disagree with your argument. We note first that the 

act requires the Department of Human Services -- not 

counties -- to set eligibility standards and application 

procedures %n accordance with" department rules relating to 

the AFDC-Medicaid program. V.T.C.S. art. 4438f, 5 1.06(a). 

In any event, although the Department of Human Services is 

to look to AFDC-Medicaid standards to fill the gaps in the 

Indigent Health Care and Treatment Act, it may not rely on 

those standards to .adopt rules that are inconsistent with 

specific provisions of the Indigent Health Care and 

Treatment Act. See Bexar Countv Bail Bond Bd. v. Deckard, 

604 S.W.2d 214, 216 (Tex. Civ. App. - San Antonio 1980, no 

writ) (administrative agencies may not. adopt rules 

inconsistent with statutory provisions). The Indigent 

Health Care and Treatment Act specifically provides that an 

applicant must provide a social security number if it is 

available. Therefore, the provisions in the Indigent Health 

Care and Treatment Act that refer to AFDC-Medicaid standards 

do not permit the Department of Human Services to enact 

rules that would deny assistance under the Indigent Health 

Care and Treatment Act to an applicant who does not have a 

social security number. 

A county may adopt its own eligibility .standards and 

application procedures, but only if the county's standards 

and procedures are less strict than those of the Department 

of Human Services. V.T.C.S. art. 4438f, 5 1.06(h); see also 

id. 5 2.04(b). Because the Department of Human Services has 

no authority to promulgate a rule requiring applicants who 

do not have a social security number to provide one, a 

county may not adopt such a requirement, since such a 

requirement would be stricter than Department of Human 

Services standards. 

Although you ask about social security numbers, your 

letter indicates that you are concerned about the provision 

of indigent health care to illegal or undocumented aliens 

who are residents of Cameron County. Any person who seeks 

county assistance under the Indigent Health Care and Treatment Act must show that he is a resident of the county. &g 

id. 5 1.03 (setting out factors to be considered in 

determining residency under the Indigent Health Care and 

Treatment Act). A residency requirement does not preclude 

an alien from receiving state services. Attorney General 

Opinion JM-962 (1988). See aenerallv St. Joseoh's H&D. and 

Medical Center v. Maricooa County, 688 P.2d 986 (Ariz. 1984) 

(undocumented alien may be a resident of county for purpose 

p. 5270 
Honorable Benjamin Euresti, Jr. - Page 5 (JM-1021) 

of receiving medical assistance under state indigent health 

care statute). A tape of a floor discussion of the Indigent 

Health Care and Treatment Act indicates that the legislature 

did not intend illegal aliens to be excluded from coverage 

under the act if they met the residency and eligibility 

requirements. Debate on S.B. 1 on Floor of the House 69th 

Leg., 1st C.S. (May 29, 1985) (tape recording available 

through House Hearing Reporter). 

SUMMARY 

A county may not deny assistance under 

the Indigent Health Care and Treatment Act, 

article 4438f, V.T.C.S., because an applicant 

does not have a social security number. 

JIM MATTOX 

Attorney General of Texas 

MARY KELLER 

First Assistant Attorney General 

LOU MCCREARY 

Executive Assistant Attorney General 

JUDGE ZOLLIE STEAKLEY 

Special Assistant Attorney General 

RICK GILPIN 

Chairman, Opinion Committee 

Prepared by Sarah Woelk 

Assistant Attorney General 

Pa 5271