Opinion ID: 2125986
Heading Depth: 1
Heading Rank: 1

Heading: Eligibility For HCI Benefits

Text: The Hospital asserts that the evidence does not support the trial court's finding that Campbell's condition lacked the degree of severity to qualify for HCI benefits. The Hospital also asserts that the evidence does not support the conclusion of the Court of Appeals that HCI did not apply because Campbell was an inmate of the Indiana Department of Corrections at the time of his admission to the Hospital. We conclude that the Hospital is correct and that the medical and non-medical eligibility requirements at issue here were met. The HCI program provides benefits for poor people who, without immediate medical attention, would suffer serious consequences. The program specifies the medical criteria necessary to qualify for benefits: A resident of Indiana who meets the income and resource standards established by the state department of public welfare under subsection (c) is eligible for assistance to pay for any part of the cost of care provided in a hospital in Indiana that was necessitated after the onset of a medical condition that manifested itself by symptoms of sufficient severity that the absence of immediate medical attention would probably result in: (1) placing the person's life in jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily organ or part. In addition, a qualified resident is eligible for assistance to pay for any part of the cost of care that is a direct consequence of the medical condition that necessitated the emergency care. Ind. Code § 12-5-6-2.1(a) (Emphasis added). This statute became effective July 1, 1986, the month prior to Campbell's admission. The HCI program is now administered and funded by the Indiana Department of Public Welfare. However, for admissions prior to January 1, 1987, like Campbell's, the county welfare departments are responsible for paying any HCI benefits. Ind. Code § 12-5-6-19. In its brief filed in the Court of Appeals, the State concedes [1] that Campbell meets the medical criteria necessary to qualify for benefits under the act because he was admitted under a 72-hour detention order. We think it is clear, as the State points out, that the statute relates to emergency care, not preventative care, and that attempted suicide meets the definition of emergency care under HCI. Here, the State recognizes in its brief that a court-ordered 72-hour detention is a situation where the medical eligibility requirements of HCI are met. We agree. Here, within two days of the admission, Campbell made two serious attempts at suicide and threatened to do so again. Those around him were concerned that he might be successful the next time. We think this appears to be placing the person's life in jeopardy and, therefore, meets the emergency medical situation contemplated by HCI. We find nothing in the words of the statute or the purpose behind it to suggest that only those emergencies with respect to a person's physical health were contemplated and that it was intended to exclude medical emergencies with respect to a person's mental health. We, therefore, conclude that when a patient is admitted to a hospital pursuant to a 72-hour detention order, the patient's mental condition, even in the absence of a physical illness, can qualify for benefits under HCI. We also conclude Campbell meets the disputed non-medical qualification under the act. The Court of Appeals concluded that because Campbell was an inmate of Noble County jail at the time he was admitted to the Hospital, he did not meet the non-medical eligibility requirements. The Court of Appeals pointed to subsection (e) as the source for this conclusion. That subsection provides: This chapter does not apply to inmates and patients of institutions of the department of correction, the state board of health, or the department of mental health. Ind. Code § 12-5-6-2.1(e). We presume that the basis for the Court of Appeals' conclusion was its equating Campbell's status as an inmate of Noble County jail with the status of being an inmate of the Indiana Department of Corrections. There is no evidence in the record that Campbell was an inmate of the Department of Corrections or that he was a patient under the care of the State Board of Health or the Department of Mental Health. Thus, there is nothing in the record to support the conclusion that Campbell comes within any of the individuals excluded from the act in subsection (e). Thus, Campbell's status as an inmate of the county jail does not preclude applicability of HCI to him. Ind. Code § 36-2-2-24 provides that the county executive, in this case the county commissioners, shall establish and maintain... a county jail... . The sheriff assumes responsibility for the county jail and its prisoners. Ind. Code § 36-2-13-5(a)(7). Persons become inmates at the Department of Corrections only after conviction. Ind. Code § 11-8-2-7(a) and Ind. Code § 11-8-1-9. In addition, Department of Corrections institutions often have medical facilities on their premises and physicians on staff. By contrast, some inmates of county jails have not been convicted of any crime, e.g., if they have been charged with a crime but are unable to raise bail. We think the statute is clear that inmates at the county jail are not necessarily inmates at the Department of Corrections. Therefore, we conclude that Campbell met this portion of the non-medical requirements for benefits under the act. The State, however, correctly points out that whether Campbell met the requisite financial eligibility requirement of the act was not determined by the administrative law judge. For that reason this case must be remanded for a determination as to whether Campbell meets this financial eligibility requirement.