Could Austin require medical-assistance applicants to use other available benefits before city funds?

Texas AG Opinion JM-470: Austin Medical Assistance

Plain-English summary

Austin's Similar Benefits Rule made city-funded medical assistance a source of last resort. It required indigent or low-income applicants to use available federal, state, private, or similar benefits before the city paid. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

JM-470 concluded that the rule did not violate a constitutional "freedom of choice." The opinion found no case recognizing a privacy right to select the source of public assistance. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

The opinion relied on decisions distinguishing protection from government interference in certain personal choices from an entitlement to public money needed to exercise those choices. It concluded that Austin could require applicants to exhaust other medical-assistance sources first. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.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

What did Austin's Similar Benefits Rule require?

It said, "no city funds shall be used" when federal, state, private, or similar benefits were available to pay for an applicant's health care. Supplemental city benefits could cover remaining medically necessary costs after other sources were exhausted or proved inadequate. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

Did the constitutional right to privacy include choosing among benefit programs?

JM-470 said no. It found no case holding that a person had a constitutional right to select the source of public assistance. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

Did the opinion recognize a constitutional entitlement to money for every protected choice?

No. The opinion quoted Harris v. McRae for the rule that the Due Process Clause "does not confer an entitlement to such funds as may be necessary to realize all the advantages of that freedom." Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

Background and statutory framework

JM-470 described Austin as a home-rule city under article XI, section 5 of the Texas Constitution, with broad authority over public health and welfare. The city council had adopted the Similar Benefits Rule by resolution in 1977. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

The opinion framed the issue as whether the privacy-based freedom of personal choice prevented a city from structuring a nonconstitutionally required benefit program as a payer of last resort. It concluded that the manner of providing such benefits was a legislative matter. Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

Citations and references

• Texas Constitution article XI, section 5
• article 1175, sections 28 and 34, V.T.C.S.
• article 1015, sections 1 and 4, V.T.C.S.
• Roe v. Wade, 410 U.S. 113, 152-53 (1973)
• Harris v. McRae, 448 U.S. 297, 312 (1980)
• Santosky v. Kramer, 455 U.S. 745, 753 (1982)
• Maher v. Roe, 432 U.S. 464, 474 (1977)
• Burgess v. City of Houston, 718 F.2d 151, 154 (5th Cir. 1983)
• Hackney v. Meade, 466 S.W.2d 341, 342 (Tex. Civ. App. - Austin 1971, writ ref'd n.r.e.)
• Schweiker v. Hogan, 457 U.S. 569, 591 (1982)

Source: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.pdf

Source

• Landing page: https://www.texasattorneygeneral.gov/opinions/jim-mattox/jm-0470
• Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1986/jm0470.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

April 8, 1986

Honorable Erwin W. Barton
Chairman
Human Services Committee
Texas House of Representatives
P. O. Box 2910
Austin, Texas 78769

Opinion No. JM-470

Re: Constitutional validity of a municipal ordinance which requires participants in a medical assistance program to apply for other available benefits

Dear Representative Barton:

You ask whether the Similar Benefits Rule which is incorporated in the Medical Assistance Program of the city of Austin violates individuals' constitutional "freedom of choice." The city of Austin's Similar Benefits Rule makes it a prerequisite to the expenditure of city funds for health care services for indigent or low income recipients that such persons must first utilize whatever "federal, state or private funds or similar benefits are available for the payment for [such] services. . . ." We find that this rule does not violate any constitutional "freedom of choice."

Austin is a Home Rule City, created pursuant to article XI, section 5 of the Texas Constitution, with broad authority to provide for the health and welfare of its citizens. V.T.C.S. art. 1175, §§28, 34. Its governing body is empowered to establish and regulate the provision of medical and health services, including the operation of hospitals. V.T.C.S. art. 1015, §§1, 4. The Austin City Council enacted the Similar Benefits Rule in 1977, by resolution, as follows:

Whenever federal, state or private funds or similar benefits are available for the payment for services to indigent or low income health care recipients, no city funds shall be used to pay for such care. Persons who are eligible for partial benefits from other third party sources may be eligible for supplemental clinic card benefits provided that such supplemental benefits are extended only as a source of payment of last resort when benefits from other sources have been exhausted or are inadequate to fully cover the cost of medically necessary services.

You ask whether this rule violates any right to "freedom of choice," to choose between various government benefit programs.

The right to "freedom of choice" in certain matters is part of the right to privacy. See Roe v. Wade, 410 U.S. 113, 152-53 (1973); see also Harris v. McRae, 448 U.S. 297, 312 (1980) (part of liberty interest protected by the Due Process Clause of the Fourteenth Amendment). The most commonly recognized matters of personal privacy involve activities and decisions regarding marriage, procreation, contraception, and a freedom of personal choice in certain other matters associated with family life. See id.; see also Santosky v. Kramer, 455 U.S. 745, 753 (1982). There are no cases which hold that a person has a constitutional right to select the source of public assistance under the right of privacy.

In Harris v. McRae, 448 U.S. 297, 316 (1980), the United States Supreme Court denied the existence of a constitutional entitlement to sufficient financial resources to participate in the full range of protected choices. See also Maher v. Roe, 432 U.S. 464, 474 (1977). As the McRae court explained,

[a]lthough the liberty protected by the Due Process Clause affords protection against unwarranted government interference with freedom of choice in the context of certain personal decisions, it does not confer an entitlement to such funds as may be necessary to realize all the advantages of that freedom.

448 U.S. at 317-18. The court reasoned that the manner of providing benefits which the government is not constitutionally required to provide is a legislative matter rather than a matter of constitutional entitlement. 448 U.S. at 318; see also Burgess v. City of Houston, 718 F.2d 151, 154 (5th Cir. 1983); Hackney v. Meade, 466 S.W.2d 341, 342 (Tex. Civ. App. - Austin 1971, writ ref'd n.r.e.).

Consequently, the constitutional right of individuals to privacy and the freedom of choice in personal matters which that right entails does not prevent the city of Austin from requiring that applicants for medical assistance which is funded by the city first exhaust other available sources of medical assistance. See also Schweiker v. Hogan, 457 U.S. 569, 591 (1982) (allocating scarce benefits on the basis of financial ability to meet needs not inconsistent with constitutional principles of equal treatment).

SUMMARY

The constitutional right of individuals to privacy and the freedom of choice in personal matters which that right entails do not prevent the city of Austin from requiring that applicants for medical assistance which is funded by the city first exhaust other available sources of medical assistance.

Very truly yours,

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 Jennifer Riggs
Assistant Attorney General