DAN MORALES

Al-rORNEY GENERAL 

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June 8.1993 

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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 561.002(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 ahospital district orpublic hospital, id subch. B.
For indigent, or “eligible,” persons who are residents of hospital distticts, section 61.055 ofthe 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’senabling legislation. Asyou 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 63;Tex. Const. art. Iy 59. Prior opinions ofthis 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 isour opinion that the ICamesCounty Hospital District is responsible for the medical costs ofanindigentjail inmate who is aresident ofthat district. Seegenerally Health & Safety Code ch. 61, subch. C.

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Also, for such an indigent imnate who is aresident 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 isliable for the medical expemes ofits prisoners, the express provisions ofthe constitution, making hospital districts, where created, responsiile for the medical care of their needy inhabitan@ must be read to prevail, even inthe situation where such a hospital district’sresident receives medical care while ineed in another county’sjail. Similarly, for indigent inmates ofthe 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 361.052 (public hospital’sresponsibiity for eligible residents ofits service area); see uko id. $561.002(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 ofthe 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 countyjail was to be borne by the county of incarceration, and not by the county of residence. Smce the issuance of Attorney General Opinion JM-643, article 104.002, subpart (d) ofthe Code of Crhninal Procedure, hasbeen 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. Jfsuch 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 civilaction.

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Acts 1991,72d Leg., ch. 434.8 l(d), at 1597-98.’ ln light ofthe current provisions ofarticle 104.002(d), itisour 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 isnot aresident 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 ofmedical care provided to such an “eligible county resident” when incarcerated in the Karnes County Jail would he uhimately with his county ofresidence. 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 ofresidency questions. Health 8cSafety Code 8861.003,61.004. Again we caution, that we cannot anticipate or resolve~ah questions that may arise with respect to indigent prisoners’he&b care expenses. We speciScaUynote, for example, that we do not consider here the responsibiity for costs ofmedical care for prisoners who are not Texas residents. Also, asthe above-quoted provisions ofarticle 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 ofthe 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 ofpayment from other sources. See, e.g., Health & Safety Code 861.022(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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SUMMARY Subject to the given caveats, the Kames County Hospital Districtisresponsiblefor 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 Jailwho does not reside inahospital district or public hospital service area isresponsible forthe costs ofhismedical care.

WILL PRYOR Fii Assistant Attorney General
MARYKELLER Deputy Attorney General forLitigation RENEA HICKS State Solicitor MADELElNE B. JOHNSON Chair, Opiion Committee Prepared by Wti M. Walker Assistant Attorney General DAN MORALES Attorney General ofTexas

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