Could Montague County pay for a resident indigent child's liver transplant when the child lived outside any public-hospital or hospital-district service area?
Apply this to your situation
This page answers the general question as of 1986. Ezel answers yours: what it means for your facts, under current Texas law, with citations.
Texas AG Opinion JM-425: County Indigent Medical Care
Plain-English summary
Montague County asked whether it could pay unpaid medical expenses, up to $25,000, for an eight-year-old county resident scheduled for a liver transplant. The child lived outside any area that a public hospital or hospital district was legally obligated to serve. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
The Indigent Health Care and Treatment Act required counties to assist eligible residents outside public-hospital and hospital-district service areas and described the county as the payor of last resort. Although that duty did not become mandatory until September 1, 1986, the absence of a current duty did not eliminate the county's authority to act earlier. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
JM-425 concluded that the commissioners court could pay for the child's medical services. Article 2351's county duty to support resident paupers included necessary medical care and did not depend on a public hospital existing in the county. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
Currency note
This opinion was issued in 1986. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.
Common questions
Did the county have to wait until the new act's mandatory date to help?
No. JM-425 distinguished between a legal obligation and legal authority. The county could provide assistance before the statutory duty became mandatory. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
Did the absence of a county public hospital prevent payment?
No. The opinion found that article 2351 did not condition county authority on the presence of a public hospital. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
What did “support of paupers” include?
The cited Texas case described it as including what was necessary for bodily health and comfort, especially proper care, attention, and treatment during sickness. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
Background and statutory framework
Senate Bill 1 enacted the Indigent Health Care and Treatment Act. Its county-responsibility section covered eligible county residents who did not live in an area a public hospital or hospital district had a legal duty to serve. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
The act took effect September 1, 1985, but delayed the requirement to provide its prescribed assistance until September 1, 1986. Assistance before that date remained governed by the law and practice in effect when it was provided. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
Citations and references
- article 4438f, V.T.C.S., Indigent Health Care and Treatment Act
- article 2351, V.T.C.S., section 11
- Senate Bill 1, 69th Legislature, First Called Session
- Monghon & Sisson v. Van Zandt County, 3 Willson 240 (Tex. Ct. App. 1886)
- Attorney General Opinions MW-33 (1979) and H-703 (1975)
Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
Source
- Landing page: https://www.texasattorneygeneral.gov/opinions/jim-mattox/jm-0425
- Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0425.pdf
Original opinion text
Best-effort transcription from a scanned PDF via OCR. Minor errors may remain; the linked PDF is authoritative.
The Attorney General of Texas
JIM MATTOX
Attorney General
February 11, 1986
Honorable Ray Farabee
Chairman
State Affairs Committee
Texas State Senate
P.O. Box 12068, Capitol Station
Austin, Texas 78711
Opinion No. JM-425
Re: Whether a county may agree to be a payor of last resort for medical services rendered to an indigent child who resides outside the hospital district
Dear Senator Farabee:
You have requested our opinion regarding the authority of the Montague County Commissioners Court to pay for medical services rendered to an indigent who is a county resident, but who does not reside within an area served by a public hospital or a hospital district. The indigent in this case is an eight-year-old girl who is scheduled to undergo a liver transplant. The commissioners court is willing to pay all unpaid expenses up to a total of $25,000.
Senate Bill No. 1, passed during the first called session of the Sixty-ninth Legislature, enacted the Indigent Health Care & Treatment Act, article 4438f, V.T.C.S., which provides the following, in pertinent part:
Sec. 2.02. GENERAL PROVISIONS. (a) Each county shall provide health care assistance as prescribed by this title to each eligible resident of that county who does not reside within the area that a public hospital or hospital district has a legal obligation to serve.
(b) The county is the payor of last resort and shall provide assistance only if other adequate public or private sources of payment are not available.
Acts 1985, 69th Leg., 1st C.S., ch. 1, § 2.02, at 8. Section 15 of Senate Bill No. 1 provides that
[S]ections 1 and 2 . . . take effect September 1, 1985, but a county, public hospital, or hospital district is not required to provide health care assistance as prescribed . . . until September 1, 1986. . . . Health care assistance provided before September 1, 1986, is governed by the law and practice in effect at the time that the assistance is provided. (Emphasis added).
Id. § 15(a), at 46. The absence of a present legal requirement to pay does not negate the existence of legal power or authority to do so.
In Attorney General Opinion MW-33 (1979), this office said that Denton County was liable for its indigents' medical expenses which are incurred at a joint city-county hospital. The opinion relied on section 11 of article 2351, V.T.C.S., which requires a county to "[p]rovide for the support of paupers" who are "residents of their county," and on Monghon & Sisson v. Van Zandt County, 3 Willson 240 (Tex. Ct. App. 1886), which held that "support" as used in article 2351 means
all that is necessary to bodily health and comfort, and especially does it include proper care, attention and treatment during sickness.
See also Attorney General Opinion H-703 (1975).
Although there was a public hospital in Monghon & Sisson and in Attorney General Opinion MW-33, neither opinion conditioned its answer upon the existence of a public hospital, and we do not believe the absence of a public hospital is controlling in the situation you pose. Moreover, section 7 of Senate Bill No. 1 repealed article 4438, requiring commissioners to finance indigent health care "[i]f there is a regular established public hospital in the county." Article 2351 makes no such distinction between the absence or presence of a public hospital and, in any event, the legislature has manifested its intent in Senate Bill No. 1 to abrogate any distinction based on whether a person is a resident of an area served by a public hospital or a hospital district. We conclude, therefore, that the Montague County Commissioners Court is authorized to pay for medical services rendered to an indigent who is a county resident but who does not reside within an area served by a public hospital or a hospital district.
SUMMARY
The Montague County Commissioners Court is authorized to pay for medical services rendered to an indigent who is a county resident but who does not reside within an area served by a public hospital or a hospital district.
JIM MATTOX
Attorney General of Texas
JACK HIGHTOWER
First Assistant Attorney General
MARY KELLER
Executive Assistant Attorney General
ROBERT GRAY
Special Assistant Attorney General
RICK GILPIN
Chairman, Opinion Committee
Prepared by Rick Gilpin
Assistant Attorney General
Get today's answer for your situation
You just read a 1986 opinion on this question. Ezel checks the current Texas statutes and case law and answers your specific situation, with citations.
Opens in Ezel Pro. Every answer cites the law it relies on.