Ala. Code
Code of Alabama

Ala. Code § 22-21-291 (2026)

Legislative Intent.

✓ official Alabama Legislature (ALISON) text, current July 2026
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It is the intent of the Legislature to place the ultimate financial obligation for the medical treatment of indigents on the county in which the indigent resides, for all those costs not fully reimbursed by other governmental programs or third-party payers.

(Acts 1979, No. 79-808, p. 1487, §2.)

Notes of Decisions
Cited in 7 cases, 1986–2012 · leading case: In re Jefferson Cnty., 484 B.R. 427 (Bankr. N.D. Ala. 2012).
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In re Jefferson Cnty., 484 B.R. 427 (Bankr. N.D. Ala. 2012). · cites it 6× “Specifically, the City Parties rely on § 22-21-291, which provides that [i]t is the intent of the Legislature to place the ultimate financial obligation for the medical treatment of indigents on the county in which the indigent resides, for all those costs not fully reimbursed…”
Health Care Auth. v. Madison Cnty., 601 So. 2d 459 (Ala. 1992). · cites it 9× “argument that had the Legislature intended for the State general fund to be responsible for these costs [the costs of caring for indigent, mentally ill persons that are involuntarily committed], it would have specifically stated so in Code of Alabama 1975, § 22-21-291 (the…”
Childree v. Health Care Auth. of City of Huntsville, 548 So. 2d 419 (Ala. 1989). · cites it 7× “IV, § 88, states that "[i]t shall be the duty of the legislature to require the several counties of this state to make adequate provision for the maintenance of the poor"; this places on Madison County the duty of caring for its indigent citizens. We agree with the Comptroller's…”
Ex Parte Univ. of South Alabama, 812 So. 2d 341 (Ala. 2001). · cites it 4× “" § 22-21-291, Ala.Code 1975. A medical provider can sue under AHCRA, and the suit "is in the nature of a suit on a contract implied by law.”
Tuscaloosa Cnty. v. Child.'s Hosp., Inc., 486 So. 2d 1302 (Ala. Civ. App. 1986). “§ 22-21-291, Code 1975. It is our considered opinion that a suit brought under AHCRA is in the nature of a suit on a contract implied by law.”
Univ. of South Alabama v. Escambia Cnty., 812 So. 2d 336 (Ala. Civ. App. 2000). · cites it 2× “” § 22-21-291. Section 22-21-293 of the Act applies to out-of-county indigents treated at a regional hospital and provides, in pertinent part: “Ultimate financial responsibility for treatment received at a regional referral hospital by a certified indigent patient, who is a…”
Lawrence Cnty. v. Decatur Gen. Hosp., 675 So. 2d 393 (Ala. 1996). “1 The legislative intent behind AHCRA is set forth in § 22-21-291: “It is the intent of the legislature to place the ultimate financial obligation for the medical treatment of indigents on the county in which the indigent resides, for all those costs not fully reimbursed by…”
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