Does a Kansas county hospital board have to get its annual budget approved by the county commission even if it isn't asking for tax money?

Plain-English summary

Southwest Medical Center (SWMC), a Seward County-owned hospital with a board appointed by the county commissioners, asked whether it always has to submit its budget to the commission for approval, or only in years when it wants to raise part of that budget through the tax authorized by K.S.A. 19-4606.

The Attorney General concluded the budget always has to go to the commission. K.S.A. 19-4607(c) requires a non-elected hospital board to prepare a budget each year, state how much of it (if any) it wants funded by the K.S.A. 19-4606 tax, and submit the whole package to the county commission for approval. A separate statute, K.S.A. 19-4610(a), gives the board exclusive control over how hospital money is actually spent once a budget is approved. The opinion read these two provisions as covering different stages of the same process: 19-4607(c) governs how the budget gets approved in the first place, and 19-4610(a) governs how the board spends money after that approval. Because they address different subjects, there is no conflict, and the submission requirement in 19-4607(c) applies regardless of whether any tax revenue is involved.

What this means for you

County hospital boards and administrators (non-elected boards): the opinion holds that your board must submit a full proposed budget to the county commission every year under K.S.A. 19-4607(c), including a statement of how much (even if zero) you want raised through the K.S.A. 19-4606 tax. Skipping submission because you aren't requesting tax funding is not supported by this opinion.

County commissioners and county counselors: the opinion confirms commissioners retain the K.S.A. 19-4607(c) review and approval role over a non-elected hospital board's budget every year, while K.S.A. 19-4610(a) still reserves control over actual expenditure decisions (other than revenue-bond money) to the board itself once the budget is approved.

Common questions

Does this apply to elected county hospital boards too?
No. The opinion is limited to non-elected boards. K.S.A. 19-4607(c) itself says that "in the case of an elected board, submission of the budget to the commission shall not be required."

Can the county commission control how the hospital spends its money once the budget is approved?
Not directly, according to the opinion. K.S.A. 19-4610(a) gives the board exclusive control over expenditures after the budget is approved, except for money raised through revenue bonds under K.S.A. 19-4616.

Background and statutory framework

SWMC is an acute-care hospital owned by Seward County and governed by a seven-member board of trustees appointed by the county commission. K.S.A. 19-4601 et seq. sets out the rules for county-owned hospitals, with different provisions depending on whether the board is elected or appointed. Because SWMC's board is appointed, the opinion applied the provisions governing non-elected boards.

K.S.A. 19-4607(c) requires the board to prepare a budget each year showing what it needs to operate, equip, maintain, and improve the hospital, along with how much of that it wants raised through the K.S.A. 19-4606 tax, and to submit the proposed budget to the commission. The commission can return the budget for amendment, and the board can resubmit it, but the commission ultimately adopts the approved budget as part of the county's regular budget.

K.S.A. 19-4610(a) separately gives the board "exclusive control of the expenditures of all hospital moneys," except money raised through revenue bonds, subject to majority board approval of each expenditure.

Applying ordinary statutory interpretation principles, and reading the two 1984-enacted provisions in pari materia so they work in harmony rather than conflict, the opinion concluded K.S.A. 19-4607(c) governs the budget-creation and approval process while K.S.A. 19-4610(a) governs spending after a budget is in place. Even treating K.S.A. 19-4610(a) as the general rule and K.S.A. 19-4607(c) as a more specific carve-out, the specific provision would still control, requiring commission approval of the budget before the board spends money as it sees fit.

Citations and references

Statutes:
- K.S.A. 19-4601 (incl. subsections (a), (b), (d))
- K.S.A. 19-4606
- K.S.A. 19-4607 (incl. (c))
- K.S.A. 19-4610 (incl. (a))
- K.S.A. 19-4616

Cases:
- Nauheim v. City of Topeka, 309 Kan. 145 (2019)
- Bruce v. Kelly, 316 Kan. 218 (2022)
- In re Marriage of Traster, 301 Kan. 88 (2014)
- State ex rel. Schmidt v. Kelly, 309 Kan. 887 (2019)

Source

• Landing page: https://www.ag.ks.gov/reports-resources/ag-opinions
• Original PDF: https://www.ag.ks.gov/home/showpublisheddocument/24738/639074562934070000

Original opinion text

The full opinion as issued by the Office of the Kansas Attorney General:

February 23, 2026

ATTORNEY GENERAL OPINION NO. 2026-6

Shirla McQueen
SWMC Chief Legal Counsel
Sharp McQueen, P.A.
419 N. Kansas Ave.
P.O. Box 2619
Liberal, KS 67905-2619

Nathanial Foreman
Seward County Counselor
Tate, Kitzke & Foreman LLC
1024 S. Trindle St.
P.O. Box 909
Hugoton, KS 67951-0909

Re: Counties and County Officers—Hospitals and Related Facilities—Organization of Board; Budget Preparation and Approval

Counties and County Officers—Hospitals and Related Facilities—Powers and Duties of Board; Expenditures and Investments

Synopsis: The Seward County Board of County Commissioners appoints Southwest Medical Center's hospital board. K.S.A. 19-4607(c) requires non-elected hospital boards to submit a proposed budget and the portion of the budget requested to be funded by a tax under K.S.A. 19-4606 to the county commissioners. K.S.A. 19-4610(a) directs that a hospital board shall have control over all expenditures, except those raised by revenue bonds. These statutes do not conflict, as they apply to two different subjects. K.S.A. 19-4607(c) directs a non-elected hospital board to submit a proposed budget to the county commissioners regardless of whether the hospital board is requesting any portion be funded by a tax under K.S.A. 19-4606. Thus, K.S.A. 19-4607(c) requires SWMC to submit its proposed budget to the Seward County Board of County Commissioners each year for approval. Cited herein: K.S.A. 19-4601; K.S.A. 19-4606; K.S.A. 19-4607; K.S.A. 19-4610; K.S.A. 19-4616.

Dear Ms. McQueen and Mr. Foreman:

As chief legal counsel for Southwest Medical Center (SWMC) and County Counselor for Seward County, you jointly ask whether a county hospital is always required to submit its budget for approval to the county commission or whether it is required to do so only when raising a tax under K.S.A. 19-4606. SWMC is an acute-care hospital facility owned by Seward County. It is governed by a seven-member Board of Trustees appointed by the Seward County Board of County Commissioners.

K.S.A. 19-4601, et seq. provides statutory requirements for the operation of county-owned hospitals. Hospital boards can either be appointed by county commissioners or elected. Parts of the act apply differently or provide different authority to the hospital board based on whether the board is elected or appointed. Because the Seward County Board of Commissioners appoints SWMC's board, the provisions applicable to elected boards do not apply here. Two statutory provisions affect your question. The first is K.S.A. 19-4607(c), which, in relevant part, states:

Prior to June 1 of each year, the board[1] shall prepare a budget showing the amount it deems necessary to operate, equip, maintain and improve the hospital for the ensuing fiscal year and the amount of that portion thereof that it deems necessary to be raised by the tax authorized under K.S.A. 19-4606, and shall submit its proposed budget to the commission[2] or, in case of an elected board, to the county clerk. If the commission does not approve the proposed budget within 10 days after receipt thereof, it shall return the budget to the board. Upon receipt of the returned budget, the board shall consider amendments or modification and may consult with the commission concerning the budget. Within 10 days after receipt of the returned budget, the board shall resubmit its proposed budget, with or without amendment or modification, to the commission. Within 10 days after resubmission of the proposed budget, the commission shall approve, or amend or modify and approve as amended or modified, such proposed budget. The commission shall adopt the proposed budget as approved and shall make the same a part of the regular county budget. In the case of an elected board, submission of the budget to the commission shall not be required. (Emphasis added).

1 As applied in this act, the "board" means "a hospital board which is selected in accordance with the provisions of this act and which is vested with the management and control of a county hospital." K.S.A. 19-4601(a).
2 As applied in this act, "commission" means the board of county commissioners. K.S.A. 19-4601(b).

The second statutory provision is K.S.A. 19-4610(a):

The board shall have the exclusive control of the expenditures of all hospital moneys[3], except hospital moneys acquired through the issuance of revenue bonds, and all expenditures shall be subject to the approval of a majority of all the members of the board.

3 "'Hospital moneys' means, but is not limited to, moneys acquired through the issuance of bonds, the levy of taxes, the receipt of grants, donations, gifts, bequests, interest earned on investments authorized by this act and state or federal aid and from fees and charges for use of and services provided by the hospital." K.S.A. 19-4601(d).

Analysis of this issue requires statutory interpretation. Statutory interpretation begins with the text of the statute, giving words their ordinary, everyday meanings.4 Only when the language is ambiguous are canons of statutory construction, legislative history, or other background information employed to discern the statute's meaning.5

4 Nauheim v. City of Topeka, 309 Kan. 145, 149-50, 432 P.3d 647 (2019).
5 Id.

The plain language of K.S.A. 19-4607(c) directs a non-elected hospital board, such as SWMC's board, to submit both a proposed budget and the portion of that budget to be raised by tax each year to the county commission without consideration as to whether the hospital board is requesting revenue via tax. Accordingly, a non-elected hospital board must submit its budget to the county commission each year for approval, regardless of whether a tax is raised to help fund the budget.

Your letter suggests a conflict exists between K.S.A. 19-4607(c) and 19-4610(a). An analysis of the two statutory provisions establish that they are not conflicting.

Even when the statutory language is clear, various provision of an act should still be considered in pari materia "to reconcile and bring those provisions into workable harmony, if possible."6 The doctrine of in pari materia "can be used as a tool to assess whether the statutory language is plain and unambiguous in the first instance, and it can provide substance and meaning to a court's plain language interpretation of a statute."7 In construing an act in pari materia, statutes are construed to avoid unreasonable or absurd results with the presumption that the Legislature did not intend to enact meaningless legislation.8

6 Bruce v. Kelly, 316 Kan. 218, 224, 514 P.3d 1007 (2022).
7 Id.
8 In re Marriage of Traster, 301 Kan. 88, 98, 339 P.3d 778 (2014).

K.S.A. 19-4607 and 19-4610 were passed together by the Legislature in 1984 as part of one act.9 As the Legislature passed these two statutes together as part of the same act, interpreting them in a manner that would put them in conflict with each other would create an absurd result. Instead, we strive to interpret them in harmony.

9 1984 Kan. Sess. Laws ch. 98, § 7, 10.

A straightforward interpretation of K.S.A. 19-4607(c) and 19-4610(a) is that they address two different topics. K.S.A. 19-4607(c) requires a board to create a budget for the hospital each year and submit it to the commissioners for approval. K.S.A. 19-4610(a) gives the board exclusive control over the actual expenditure of hospital moneys, except when acquired by revenue bonds.

The process works as follows. K.S.A. 19-4607(c) applies to the budget-creation process. A board must create a proposed budget and send it to the commission, with a statement of the proportion of the budget that requires a tax for approval. K.S.A. 19-4607(c) goes on to explain the approval process, including permitting a commission to amend or modify the proposed budget after resubmission. K.S.A. 19-4610(a), on the other hand, applies to the actual spending of hospital moneys after a budget's creation. After a budget has been approved for the hospital for the year, the board controls the expenditure decisions, except for hospital moneys raised via revenue bonds. The commission lacks authority to direct specific spending decisions, with the sole exception being revenue bonds, which have a specific statutory purpose.10 Therefore, K.S.A. 19-4607(c) and 19-4610(a) work harmoniously within the act by applying to two different subjects.

10 See K.S.A. 19-4616.

Even if K.S.A. 19-4607(c)'s allowance of a commission to amend or modify a proposed budget on resubmission were interpreted to conflict with K.S.A. 19-4610(a)'s grant of exclusive control over hospital moneys, the ultimate conclusion would remain the same. Specific statutes control over general statues.11 Here, K.S.A. 19-4610(a) is the general statute, and K.S.A. 19-4607(c) the specific statute. K.S.A. 19-4610(a) creates a general authority to a board to control hospital moneys. But, within that monetary realm, K.S.A. 19-4607(c) requires all hospital budgets from non-elected boards to be approved by the commission. Thus, it operates, as the specific statute, as a carve out to require a board to obtain commission approval of a budget before the board can spend the money as it deems best.

11 State ex rel. Schmidt v. Kelly, 309 Kan. 887, 898, 441 P.3d 67 (2019).

Accordingly, SWMC's board must submit its proposed budget to the commissioners for approval. K.S.A. 19-4607(c) states that a board "shall" prepare a budget showing the amount it deems necessary "and the amount of that portion thereof that it deems necessary to be raised by the tax authorized under K.S.A. 19-4606." The statute then directs that the board "shall submit its proposed budget to the commission." K.S.A. 19-4607(c) requires a board to prepare a budget and submit it to the commission. With that budget, the board also must state the amount it believes necessary to raise from a tax under K.S.A. 19-4606. "Shall" in this statute denotes mandatory language.12 As such, K.S.A. 19-4607(c)'s direction applies even if the requested portion raised via tax is $0. The portion the board intends to fund via tax is required by statue to accompany the proposed budged.

12 See Antonin Scalia & Bryan A. Garner, Reading Law: The Interpretation of Legal Texts 114 (2012) ("[W]hen the word shall can reasonably be read as mandatory, it ought to be so read.").

K.S.A. 19-4607(c) and 19-4610(a) work in harmony. The plain language of K.S.A. 19-4607(c) requires the budget be submitted to the commission along with the amount the board deems necessary to be raised from a tax under K.S.A. 19-4606. SWMC is thus required to submit its budget to the Seward County Board of Commissioners for approval, even if it does not intend to fund any portion of its budget from a tax raised under K.S.A. 19-4606.

Sincerely,

/s/ Kris W. Kobach

Kris W. Kobach
Attorney General

/s/ Ryan J. Ott

Ryan J. Ott
Assistant Solicitor General