DAN MORALES 

Al-rORNEY GENERAL 

QBffice of tfie JZMmep 

&ate of Qexarl 

June 8.1993 

@eneral 

Honorable Clan R Cannon 

Rames County Auditor 

200 Bast calvert 

Kames City, Texas 78118 

Opiion No. DM-225 

Re: Liabiity for costs of health care 

provided to indigent inmates of the Rames 

County Jail (RQ-420) 

Dear Mr. Cannon: 

You ask who is responsible for paying medical bills for indigent prisoners 

inumerated in Kames County Jail. We cannot anticipate all issues that may arise with 

respect to responsibiity for the costs of indigent prisoners’ medical care. We offer the 

following discussion for your general guidance. 

We note first that, for purposes of the following discussion “indigent” will mean 

“eligible” as used in the terms “eligible county resident” or “eligible resident” in the 

Indigent Health Care and Treatment Act, codiied as chapter 61 of the Health and Safety 

Code. See Health & Safety Code 5 61.002(3). (4) (detinitions). That act provides 

generally for hospital districts’ or public hospitals’ responsibiity for the costs of providing 

medical care for their “eligible residents,” id subch. C, and for counties’ responsibiity for 

such costs for “eligible county residents,” i.e., those who do not reside in the service area 

of a hospital district or public hospital, id subch. B. 

For indigent, or “eligible,” persons who are residents of hospital distticts, section 

61.055 of the Indigent Health Care and Treatment Act (the “act”) provides that a hospital 

district must provide the he&b care services and treatment required by the constitution 

and the district’s enabling legislation. As you indicate, the Rames County Hospital District 

has been created in Kames County and is coextensive with the county. Acts 1%9,61st 

Leg., ch. 591. at 1764. The district’s enabling act and the constitution require the district 

to provide medical care for its needy residents or inhabitants. Id 6 3; Tex. Const. art. Iy 

5 9. Prior opinions of this office have consistently 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 General Qpiions JM-643 (1987); JM-487 (1986); H-703 

(1975). Thus, it is our opinion that the ICames County Hospital District is responsible for 

the medical costs of an indigent jail inmate who is a resident of that district. See generally 

Health & Safety Code ch. 61, subch. C. 

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Honorable Clem R Cannon - Page 2 (DM-225) 

Also, for such an indigent imnate who is a resident of another hospital district, the 

hospital district of his residence is responsible for the costs of medical care, pursuant to 

that district’s enabling legislation and the requirements of the constitution. Attorney 

General Opiions JM-643; JM-487. As noted in Attorney General Opiion JM-643 in 

1987, despite the indication in subpart (a) of article 104.002 of the Code of Criminal 

Procedure and its predecessor provisions that the county is liable for the medical expemes 

of its prisoners, the express provisions of the constitution, making hospital districts, where 

created, responsiile for the medical care of their needy inhabitan@ must be read to 

prevail, even in the situation where such a hospital district’s resident receives medical care 

while ineed in another county’s jail. 

Similarly, for indigent inmates of the Karnes County Jail who reside in the service 

area of a public hospital, it is the public hospital which is ultimately responsible for the 

cost of health care provided at the jail. See He&b & Safety Code 3 61.052 (public 

hospital’s responsibiity for eligible residents of its service area); see uko id. $5 61.002(11) 

(detinhion of public hospital), 61.051(b) (hospitals not considered public hospitals), 

61.054 (service obligations), 61.060 (liability for payment for services provided). 

With respect to an indigent inmate of the Karnes County Jail who does not reside 

in Karnes County and whose residence is not embraced in any hospital district or public 

hospital service area, we note Srst that Attorney General Opiion JM-643 con&ded, in 

1987, that the liabiity for medical care of such indigent inmates of a county jail was to be 

borne by the county of incarcera tion, and not by the county of residence. Smce the 

issuance of Attorney General Opinion JM-643, article 104.002, subpart (d) of the Code of 

Crhninal Procedure, has been amended. Subpart (d) anrently provides: 

Apersonwhoisorwasaprisonerinacountyjailandreceived 

medical, dental, or health related services from a county or a hospital 

district shall be required tr, pay for such se&es when they are 

rendered. Jf such prisoner is an eligible county resident as defined in 

Section 61.002, Health and Safety Code, the county or hospital 

district providing the services has a right of subrogation to the 

prisoner% right of recovety from any sourw limited to the cost of 

aetvices provided. A prisoner, unless the prisoner fitlly pays for the 

cost of services received, shall remain obtigated to reimburse the 

county 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 

Safety Code. A county or hospital district shah have the authority to 

recover the.amount expended in a civil action. 

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HonorableClemR Cannon - Page 3 (~~-225) 

Acts 1991,72d Leg., ch. 434.8 l(d), at 1597-98.’ 

ln light of the current provisions of article 104.002(d), it is our opinion the costs of 

medical care provided to a prisoner who is an “eligible county resident” as deftned in the 

Indigent Health Care and Treatment Act, section 61.002~Le., one who is not a resident of 

a hospital district or public hospital service area-are now payable under the latter act. 

Section 61.022 of that act makes a county ultimately responsiile for health care for its 

“eligible county residents.” Thus, responsibiity for costs of medical care provided to such 

an “eligible county resident” when incarcerated in the Karnes County Jail would he 

uhimately with his county of residence. See also V.T.C.S. art. 2351, subdiv. 6; Attorney 

Oenerd Opiions JM-552 (1986); MW-33 (1979). 

In that the question of residence decides the matter of responsibility for medical 

care in the instances discussed above, we note the Health and Safety Code provides for 

the resolution of residency questions. Health 8c Safety Code 88 61.003,61.004. 

Again we caution, that we cannot anticipate or resolve~ah questions that may arise 

with respect to indigent prisoners’ he&b care expenses. We speciScaUy note, for example, 

that we do not consider here the responsibiity for costs of medical care for prisoners who 

are not Texas residents. Also, as the above-quoted provisions of article 104.002(d) clearly 

anticipate, Kames County or its hospital district may have recourse to other sources of 

payment for indigent ptisoners’ health care costs depending on the thcts of the particular 

case. The provisions of the Indigent Health Care and Treatment Act fbrther make it dear 

that the above-discussed entities’ ultimate responsiiity for such costs may depend on the 

availability of payment from other sources. See, e.g., Health & Safety Code 8 61.022(b) 

(wunty as “payor of last resort”). Also, eligibility requirements and the kind of care 

covered may vary depending on the particular entity responsible. See, e.g., id. @ 61.008, 

61.023,61.052; Attorney General Opinion DM-37 (1991). 

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Honorable Clan R. Cannon - Page 4 (DM-225) 

SUMMARY 

Subject to the given caveats, the Kames County Hospital 

District is responsible for the wsts of medical care provided to its 

indigent residents incarcunted in the Kames County Jail. Other 

hospital districts or public hospitals are responsible for such costs 

with respect to their indigent residents incar~ed in the Kames 

County Jail. The wunty of residence of an indigent inmate of the 

Kames County Jail who does not reside in a hospital district or public 

hospital service area is responsible for the costs of his medical care. 

WILL PRYOR 

Fii Assistant Attorney General 

MARYKELLER 

Deputy Attorney General for Litigation 

RENEA HICKS 

State Solicitor 

MADELElNE B. JOHNSON 

Chair, Opiion Committee 

Prepared by Wti M. Walker 

Assistant Attorney General 

DAN MORALES 

Attorney General of Texas 

p. 1175