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Court of Appeal, Third District, California.

Robert S. CAULK, as Director, etc. et al., Petitioners, v. SUPERIOR COURT of Sacramento County, Respondent, Leonard Patrick SILVA et al., Real Parties in Interest.

No. C015355.

Decided: June 27, 1997

L.B. Elam, County Counsel, Carmichael, Michele Bach, Supervising Deputy County Counsel, Sacramento, for Petitioners. No Appearance for Respondent. Legal Services of Northern California, Curtis L. Child, Eugenie Denise Mitchell, Karen A. Wells, Sacramento, Western Center on Law & Poverty, Melinda R. Bird, Richard A. Rothschild, and Robert D. Newman, Los Angeles, for Real Parties in Interest. California Medical Association, Catherine I. Hanson, Astrid Meghrigian, San Francisco, California Association of Hospitals & Health Systems, Lois Richardson, Remcho, Johansen & Purcell, Robin B. Johansen, Joseph Remcho, San Francisco, and Philip C. Monrad, Oakland, Amicus Curiae.

Welfare and Institutions Code section 17000 requires every county in the State to “relieve and support” the poor whenever such relief and support is not otherwise provided.  (Further statutory references to sections of an undesignated code are to the Welfare and Institutions Code.) General Assistance (GA) is the program through which counties meet this obligation.

Section 17000.5 establishes a formula which counties may use to set GA grant levels.   Benefits provided pursuant to this formula are conclusively presumed to satisfy the State mandate. (§ 17000.5, subd. (b).)  Counties that take shelter in the “safe harbor” of section 17000.5 (Ingredient Communication Council, Inc. v. Lungren (1992) 2 Cal.App.4th 1480, 1485, 4 Cal.Rptr.2d 216) are protected from the vagaries of “budget busting” litigation over this aspect of their welfare program (see, e.g., Poverty Resistance Center v. Hart (1989) 213 Cal.App.3d 295, 271 Cal.Rptr. 214).

We consider here whether a general assistance standard of aid adopted pursuant to section 17000.5 sufficiently satisfies a county's obligation not only to provide recipients of aid with food, clothing and shelter, but also with medical care.   As we shall explain, we conclude it does.


General Assistance (GA) is the program of last resort for those unable to qualify for other types of public assistance.  (Boehm v. Superior Court (1986) 178 Cal.App.3d 494, 499, 223 Cal.Rptr. 716 (Boehm II ).)   In a series of cases beginning with Boehm v. County of Merced (1985) 163 Cal.App.3d 447, 209 Cal.Rptr. 530 (Boehm I ), courts interpreted section 17000 to require that GA grant levels be based upon a study of minimum subsistence needs (a Boehm study).  (See, e.g., Boehm II, 178 Cal.App.3d at p. 501, 223 Cal.Rptr. 716;  Poverty Resistance Center v. Hart, supra, 213 Cal.App.3d at p. 304, 271 Cal.Rptr. 214;  Guidotti v. County of Yolo (1989) 214 Cal.App.3d 1552, 1562-1563, 271 Cal.Rptr. 858;  Whitfield v. Board of Supervisors (1991) 227 Cal.App.3d 451, 460, 277 Cal.Rptr. 815.)   Section 17000.5 was enacted in reaction to these cases.  (Oberlander v. County of Contra Costa (1992) 11 Cal.App.4th 535, 542, 15 Cal.Rptr.2d 182.)   It authorizes counties to adopt GA grant levels equal to 62 percent of the 1991 federal official poverty line with optional, annual adjustments equal to any adjustments in benefits provided by the State under its Aid to Families with Dependent Children (AFDC) program.1  Since GA grant levels adopted pursuant to this section are conclusively presumed adequate, they need not be supported by a Boehm study.

Since 1983, the County of Sacramento (County) has provided medical care to indigent residents through the County Medically Indigent Services Program (CMISP).   Prior to November 1, 1992, CMISP eligibility standards (the old CMISP standards) closely approximated those of State Medi-Cal at the time CMISP was inaugurated.2  On October 6, 1992, County adopted Resolution No. 92-1497, establishing new CMISP standards restricting eligibility to individuals meeting GA standards set in accordance with section 17000.5 (the new CMISP standards).   The new CMISP standards were scheduled to go into effect on November 1, 1992.

Real parties in interest (plaintiffs) are individuals eligible for medical benefits under the old CMISP standards who would be denied benefits under the new CMISP standards.   On October 29, 1992, they initiated an action in the superior court on behalf of themselves and all others similarly situated against County, its Board of Supervisors, and certain County officials (collectively defendants) to enjoin implementation of the new CMISP standards.

The superior court issued a preliminary injunction granting the requested relief.   The court concluded plaintiffs are likely to prevail on the merits of their challenge to the new CMISP standards and are likely to suffer greater harm if a preliminary injunction is denied than defendants would suffer if it is granted.   On the merits, the court explained that because those eligible for a GA grant are also entitled to medical services through CMISP, County did not intend the GA grant to include subsistence medical needs.   Defendants were directed to adopt new CMISP eligibility standards and, in the interim, to provide full medical benefits to those meeting the new CMISP standards and, as to those meeting only the old CMISP standards, to provide “medical services necessary for the treatment of acute life and limb threatening conditions and emergency medical services”.3

In response to the preliminary injunction, County adopted Resolution No. 93-0056.   As before, County set GA standards in accordance with section 17000.5.   This time, however, County expressly declared the GA standards include an allowance for subsistence medical needs, thereby eliminating County's obligation to provide such care independently.   However, in the exercise of its police powers, County directed that CMISP eligibility nevertheless be extended to those meeting GA standards.

County also adopted contingent standards for CMISP eligibility (the contingent CMISP standards) to go into effect in the event the new CMISP standards are held unlawful in a final judgment.   The contingent CMISP standards set an upper eligibility limit for free medical care at the corresponding GA level plus average per capita cost of indigent medical care ($95) and an income disregard ($50) to compensate for any error in the use of an average per capita cost figure.

On January 26, 1993, defendants moved to dissolve the preliminary injunction or to stay its operation pending appellate review.   The superior court denied the motion, finding neither the new CMISP standards nor the contingent CMISP standards satisfy County's obligations under section 17000.   The court expressly indicated medical benefits are not subject to section 17000.5 and, hence, must be provided in addition to GA benefits, with eligibility established according to subsistence medical needs.4

Defendants appealed from both the order granting the preliminary injunction and the order denying their motion to dissolve it.   Defendants also initiated the instant mandamus proceeding to compel the trial court to vacate these orders.   We issued an alternative writ and suspended proceedings on the appeal pending resolution of this matter.


 Review of an order granting a preliminary injunction is limited to “a consideration whether the trial court abused its discretion in ‘ “evaluat[ing] two interrelated factors․   The first is the likelihood that the plaintiff will prevail on the merits at trial.   The second is the interim harm that the plaintiff is likely to sustain if the injunction were denied as compared to the harm the defendant is likely to suffer if the preliminary injunction were issued.” ’ ”  (People ex rel. Gallo v. Acuna (1997) 14 Cal.4th 1090, 1109, 60 Cal.Rptr.2d 277, 929 P.2d 596, citations omitted.)   Although mandamus normally will not lie to control the exercise of judicial discretion (Cooke v. Superior Court, supra, 213 Cal.App.3d at p. 408, 261 Cal.Rptr. 706), where there is no likelihood of success on the merits, discretion can be exercised in only one way and a preliminary injunction issued in favor of the plaintiff is an abuse thereof.  (See Scates v. Rydingsword (1991) 229 Cal.App.3d 1085, 1096, 280 Cal.Rptr. 544.) 5

 At the time the superior court issued the preliminary injunction, section 17000.5, subdivision (a) read:  “The board of supervisors in any county may adopt a general assistance standard of aid, including the value of in-kind aid, that is 62 percent of a guideline that is equal to the 1991 federal official poverty line and may annually adjust that guideline in an amount equal to any adjustment provided under Chapter 2 (commencing with Section 11200) of Part 3 for establishing a maximum aid level in the county.”  (Stats.1992, ch. 722, § 139.)  “The adoption of a standard of aid pursuant to this section shall constitute a sufficient standard of aid.” (§ 17000.5, subd. (b).)  In other words, GA grant levels established pursuant to section 17000.5 are conclusively presumed to fulfill the county's relief obligation whether or not they in fact meet basic needs.  (Taylor v. County of Contra Costa (1996) 48 Cal.App.4th 1709, 1711, 56 Cal.Rptr.2d 448.)

 A county choosing to take advantage of the safe harbor provided by section 17000.5 may set its GA grant level either in accordance with the formula in section 17000.5 or at a level reduced commensurate with the value of “in-kind” benefits provided.  (Oberlander v. County of Contra Costa, supra, 11 Cal.App.4th at p. 545, 15 Cal.Rptr.2d 182.)   The issue before us is whether medical benefits are a type of “aid” which counties may provide either as a part of a GA grant or in kind, with a commensurate reduction in the GA grant.6

In Gardner v. County of Los Angeles (1995) 34 Cal.App.4th 200, 40 Cal.Rptr.2d 271 (Gardner ), the Court of Appeal answered this question in the negative.  Gardner was a class action lawsuit brought by indigent residents of Los Angeles County to oppose a plan by the county to reduce GA grants commensurate with an estimate of the value of medical benefits provided under a separate program.   After considering historical context and how section 17000 fits into the overall statutory scheme of welfare benefits, the court concluded medical benefits are not “aid” within the meaning of that provision.  (34 Cal.App.4th at pp. 226-227, 40 Cal.Rptr.2d 271.)   The court was particularly persuaded by the contrast between section 17001, requiring counties to adopt “standards of aid and care,” and section 17000.5, permitting counties to adopt a GA “standard of aid.”  (34 Cal.App.4th at pp. 216-217, 40 Cal.Rptr.2d 271.)   The court also found significant the 1977 amendment to the definition of “aid” in section 10052, which deleted mention of medical care (34 Cal.App.4th at p. 217, 40 Cal.Rptr.2d 271), section 16990, which requires counties receiving State funding for health care to maintain a specified level of support for health services (34 Cal.App.4th at pp. 218-219, 40 Cal.Rptr.2d 271), and the fact the formula used in section 17000.5 is based on AFDC benefit levels and AFDC beneficiaries receive medical care in addition to AFDC grants (34 Cal.App.4th at pp. 219-220, 40 Cal.Rptr.2d 271).

We need not concern ourselves with whether Gardner was correctly decided.   In 1996, the Legislature amended section 17000.5.   Subdivision (a), with the language added by the 1996 amendment italicized, now reads:  “The board of supervisors in any county may adopt a general assistance standard of aid, including the value of in-kind aid which includes, but is not limited to, the monthly actuarial value of up to forty dollars ($40) per month of medical care, that is 62 percent of a guideline that is equal to the 1991 federal official poverty line and may annually adjust that guideline in an amount equal to any adjustment provided under Chapter 2 (commencing with Section 11200) of Part 3 for establishing a maximum aid level in the county.   This subdivision is not intended to either limit or expand the extent of the duty of counties to provide health care.”  (Italics added.)

It is an established rule of law that on appeal from a judgment granting or denying injunctive relief, the law to be applied is that which is current at the time of the appellate court opinion.  (Kash Enterprises, Inc. v. City of Los Angeles (1977) 19 Cal.3d 294, 306, fn. 6, 138 Cal.Rptr. 53, 562 P.2d 1302;  Complete Service Bureau v. San Diego Medical Society (1954) 43 Cal.2d 201, 207, 272 P.2d 497;  Cal-Dak Co. v. Sav-On Drugs, Inc. (1953) 40 Cal.2d 492, 496-497, 254 P.2d 497.)  “Relief by injunction operates in futuro, and the right to it must be determined as of the date of decision by an appellate court.”  (American Fruit Growers v. Parker (1943) 22 Cal.2d 513, 515, 140 P.2d 23.)

In matters of statutory construction our fundamental concern is with legislative intent.  (Brown v. Kelly Broadcasting Co. (1989) 48 Cal.3d 711, 724, 257 Cal.Rptr. 708, 771 P.2d 406.)   In order to determine intent, we begin with the language of the statute.  (48 Cal.3d at p. 724, 257 Cal.Rptr. 708, 771 P.2d 406.)   If the language is clear, there is no need to resort to other indicia of intent;  there is no need for further construction.  (Lungren v. Deukmejian (1988) 45 Cal.3d 727, 735, 248 Cal.Rptr. 115, 755 P.2d 299.)   We presume the enacting body is aware of existing laws and judicial constructions in effect at the time legislation is enacted.  (People v. Weidert (1985) 39 Cal.3d 836, 844-845, 218 Cal.Rptr. 57, 705 P.2d 380.)   We also presume that when the Legislature alters the language of a given law it intends to change its meaning.  (Dix v. Superior Court (1991) 53 Cal.3d 442, 461, 279 Cal.Rptr. 834, 807 P.2d 1063.)

 We need look no further than the language of section 17000.5, as amended, to discern legislative intent.   Prior appellate decisions have established that a county may satisfy its section 17000 obligations through grants computed according to the formula described in section 17000.5 or, in whole or in part, through in-kind aid.   Revised section 17000.5 establishes that in-kind aid “includes, but is not limited to, the monthly actuarial value of up to forty dollars ($40) per month of medical care.”   Hence, as with other types of in-kind aid, counties may either discontinue medical care for those receiving GA benefits set according to section 17000.5 or continue to provide such benefits and deduct up to $40 from the GA grant levels.   There is no other reasonable interpretation.   The concluding sentence of section 17000.5, subdivision (a), which indicates the subdivision “is not intended to either limit or expand the extent of the duty of counties to provide health care [,]” merely explains that section 17000.5 does not define the counties' duty to provide health care but provides an alternate means of satisfying it.

Our conclusion section 17000.5, as amended, encompasses the counties' obligation to provide medical benefits is not affected by the recent decision in County of San Diego v. State of California, supra, 15 Cal.4th 68, 61 Cal.Rptr.2d 134, 931 P.2d 312.   That decision involved the question whether the 1983 transfer to the counties of the obligation to provide medical care to adult MIP's imposed a state mandate within the meaning of California Constitution, article XIII B, section 6, requiring state reimbursement.   The court answered the question in the affirmative, concluding counties have an absolute obligation to provide medical care to adult MIP's. (15 Cal.4th at p. 100, 61 Cal.Rptr.2d 134, 931 P.2d 312.)   However, that conclusion was based on an interpretation of the counties' general obligation under section 17000 to relieve and support indigents.   It did not involve the issue presented here, whether such general obligation may be satisfied through section 17000.5's safe harbor.

In light of the recent amendment to section 17000.5, the preliminary injunction prohibiting County from implementing the new CMISP standards cannot stand.   County set GA grant levels for 1992 in accordance with section 17000.5 and restricted CMISP eligibility to those entitled to GA benefits.   Because the GA grant levels set by County do not reflect a reduction for medical benefits, County was not required to provide such benefits “in-kind” to GA beneficiaries.   Nevertheless, in the exercise of its police powers, County was free to do so.   County need not expressly declare that medical benefits are included in the GA grant levels, as it did in Ordinance No. 93-0056, in order to take advantage of the safe harbor of section 17000.5.   Grant levels are deemed to include all forms of aid unless otherwise excluded.7

Because there is no likelihood plaintiffs will prevail on the merits of their action, a peremptory writ of mandate will issue directing the superior court to dissolve the preliminary injunction.   The parties shall bear their own costs on appeal.


1.   At the time of enactment of section 17000.5, AFDC benefit levels were approximately 62 percent of the federal official poverty line.

2.   Medi-Cal is the State program enacted pursuant to the federal Medicaid Act (title XIX of the Social Security Act;  42 U.S.C. § 1396 et seq.) to provide health care services to recipients of public assistance and others.  (Morris v. Williams (1967) 67 Cal.2d 733, 738, 63 Cal.Rptr. 689, 433 P.2d 697.)   As originally enacted, Medi-Cal eligibility was limited to “categorically linked persons”, i.e., those linked to a federal aid program by age, blindness, disability, or membership in a family with dependent children within the meaning of the AFDC program.  (County of San Diego v. State of California (1997) 15 Cal.4th 68, 77, 61 Cal.Rptr.2d 134, 931 P.2d 312.)   Later, coverage was extended to certain noncategorically linked persons who met the income and resource requirements of AFDC but who did not otherwise qualify for public assistance-“medically indigent persons” (MIP's).  (15 Cal.4th at p. 79, 61 Cal.Rptr.2d 134, 931 P.2d 312.)   By 1979, the State had assumed full responsibility for funding the State's share of the Medi-Cal program.  (15 Cal.4th at p. 79, 61 Cal.Rptr.2d 134, 931 P.2d 312.)Beginning January 1, 1983, the Legislature revised the Medi-Cal program to exclude coverage for adult MIP's, thereby effectively transferring responsibility for their health care to the counties.   The Legislature also established the Medically Indigent Services Account as a mechanism for transferring funds to the counties to supplement county health services.  (15 Cal.4th at pp. 79-80, 61 Cal.Rptr.2d 134, 931 P.2d 312;  Cooke v. Superior Court (1989) 213 Cal.App.3d 401, 411, 261 Cal.Rptr. 706.)

3.   The court denied plaintiffs' additional requests to compel defendants to provide medical benefits to Medi-Cal beneficiaries unable to obtain services elsewhere and to compel a Boehm study of nonmedical subsistence needs before adoption of revised CMISP standards.   The propriety of these rulings is not before us.

4.   The court also denied plaintiffs' request for reconsideration of its refusal to compel a Boehm study of nonmedical subsistence needs.   The propriety of this ruling is not before us.

5.   Mandamus will not lie where there is a plain, speedy and adequate remedy in the ordinary course of law.  (Code Civ. Proc., § 1086.)   Although defendants have appealed from the trial court's orders, our issuance of an alternative writ constitutes a determination that appeal is not an adequate remedy.  (See Cooke v. Superior Court, supra, 213 Cal.App.3d at p. 408, fn. 5, 261 Cal.Rptr. 706.)

6.   As previously explained, County has chosen to consider medical benefits as falling within the GA grant levels established pursuant to section 17000.5.   However, in the exercise of its police power, County has decided to provide medical benefits to those meeting GA standards.

7.   Having so concluded, we need not decide whether the contingent CMISP standards satisfy County's section 17000 obligation to provide subsistence medical care.

PUGLIA, Presiding Justice.

SIMS and NICHOLSON, JJ., concur.

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