Full opinion text
Opinion CHIN, J. Section 6 of article XIII B of the California Constitution (section 6) requires the State of California (state), subject to certain exceptions, to “provide a subvention of funds to reimburse” local governments “[wjhenever the Legislature or any state agency mandates a new program or higher level of service . . . .” In this action, the County of San Diego (San Diego or the County) seeks reimbursement under section 6 from the state for the costs of providing health care services to certain adults who formerly received medical care under the California Medical Assistance Program (Medi-Cal) (see Welf. & Inst. Code, § 14063) because they were medically indigent, i.e., they had insufficient financial resources to pay for their own medical care. In 1979, when the electorate adopted section 6, the state provided Medi-Cal coverage to these medically indigent adults without requiring financial contributions from counties. Effective January 1, 1983, the Legislature excluded this population from Medi-Cal. (Stats. 1982, ch. 328, §§ 6, 8.3, 8.5, pp. 1574-1576; Stats. 1982, ch. 1594, §§ 19, 86, pp. 6315, 6357.) Since that date, San Diego has provided medical care to these individuals with varying levels of state financial assistance. To resolve San Diego’s claim, we must determine whether the Legislature’s exclusion of medically indigent adults from Medi-Cal “mandate[d] a new program or higher level of service” on San Diego within the meaning of section 6. The Commission on State Mandates (Commission), which the Legislature created to determine claims under section 6, has ruled that section 6 does not apply to the Legislature’s action and has rejected reimbursement claims like San Diego’s. (See Kinlaw v. State of California (1991) 54 Cal.3d 326, 330, fn. 2 [285 Cal.Rptr. 66, 814 P.2d 1308] (Kinlaw).) The trial court and Court of Appeal in this case disagreed with the Commission, finding that San Diego was entitled to reimbursement. The state seeks reversal of this finding. It also argues that San Diego’s failure to follow statutory procedures deprived the courts of jurisdiction to hear its claim. We reject the state’s jurisdictional argument and affirm the finding that the Legislature’s exclusion of medically indigent adults from MediCal “mandate[d] a new program or higher level of service” within the meaning of section 6. Accordingly, we remand the matter to the Commission to determine the amount of reimbursement, if any, due San Diego under the governing statutes. I. Funding of Indigent Medical Care Before the start of Medi-Cal, “the indigent in California were provided health care services through a variety of different programs and institutions.” (Assem. Com. on Public Health, Preliminary Rep. on Medi-Cal (Feb. 29, 1968) p. 3 (Preliminary Report).) County hospitals “provided a wide range of inpatient and outpatient hospital services to all persons who met county indigency requirements whether or not they were public assistance recipients. The major responsibility for supporting county hospitals rested upon the counties, financed primarily through property taxes, with minor contributions from” other sources. {Id. at p. 4.) Medi-Cal, which began operating March 1, 1966, established “a program of basic and extended health care services for recipients of public assistance and for medically indigent persons.” (Morris v. Williams (1967) 67 Cal.2d 733, 738 [63 Cal.Rptr. 689, 433 P.2d 697] (Morris); id. at p. 740; see also Stats. 1966, Second Ex. Sess. 1965, ch. 4, § 2, p. 103.) It “represented] California’s implementation of the federal Medicaid program (42 U.S.C. §§ 1396-1396v), through which the federal government provide[d] financial assistance to states so that they [might] furnish medical care to qualified indigent persons. [Citation.]” (Robert F. Kennedy Medical Center v. Belshé (1996) 13 Cal.4th 748, 751 [55 Cal.Rptr.2d 107, 919 P.2d 721] (Belshé).) “[B]y meeting the requirements of federal law,” Medi-Cal “qualified] California for the receipt of federal funds made available under title XIX of the Social Security Act.” (Morris, supra, 67 Cal.2d at p. 738.) “Title [XIX] permitted the combination of the major governmental health care systems which provided care for the indigent into a single system financed by the state and federal governments. By 1975, this system, at least as originally proposed, would provide a wide range of health care services for all those who [were] indigent regardless of whether they [were] public assistance recipients . . . .” (Preliminary Rep., supra, at p. 4; see also Act of July 30, 1965, Pub.L. No. 89-97, § 121(a), 79 Stat. 286, reprinted in 1965 U.S. Code Cong. & Admin. News, p. 378 [states must make effort to liberalize eligibility requirements “with a view toward furnishing by July 1, 1975, comprehensive care and services to substantially all individuals who meet the plan’s eligibility standards with respect to income and resources”].) However, eligibility for Medi-Cal was initially limited only to persons linked to a federal categorical aid program by age (at least 65), blindness, disability, or membership in a family with dependent children within the meaning of the Aid to Families with Dependent Children program (AFDC). (See Legis. Analyst, Rep. to Joint Legis. Budget Com., Analysis of 1971-1972 Budget Bill, Sen. Bill No. 207 (1971 Reg. Sess.) pp. 548, 550 (1971 Legislative Analyst’s Report).) Individuals possessing one of these characteristics (categorically linked persons) received full benefits if they actually received public assistance payments. (Id. at p. 550.) Lesser benefits were available to categorically linked persons who were only medically indigent, i.e., their income and resources, although rendering them ineligible for cash aid, were “not sufficient to meet the cost of health care.” (Morris, supra, 67 Cal.2d at p. 750; see also 1971 Legis. Analyst’s Rep., supra, at pp. 548, 550; Stats. 1966, Second Ex. Sess. 1965, ch. 4, § 2, pp. 105-106.) Individuals not linked to a federal categorical aid program (non-categorically linked persons) were ineligible for Medi-Cal, regardless of their means. Thus, “a group of citizens, not covered by Medi-Cal and yet unable to afford medical care, remained the responsibility of’ the counties. (County of Santa Clara v. Hall (1972) 23 Cal.App.3d 1059, 1061 [100 Cal.Rptr. 629] (Hall).) In establishing Medi-Cal, the Legislature expressly recognized this fact by enacting former section 14108.5, which provided: “The Legislature hereby declares its concern with the problems which will be facing the counties with respect to the medical care of indigent persons who are not covered [by Medi-Cal] . . . and . . . whose medical care must be financed entirely by the counties in a time of heavily increasing medical costs.” (Stats. 1966, Second Ex. Sess. 1965, ch. 4, § 2, p. 116.) The Legislature directed the Health Review and Program Council “to study this problem and report its findings to the Legislature no later than March 1, 1967.” (Ibid.) Moreover, although it required counties to contribute to the costs of Medi-Cal, the Legislature established a method for determining the amount of their contributions that would “leave them with Qsufficient funds to provide hospital care for those persons not eligible for Medi-Cal.” (Hall, supra, 23 Cal.App.3d at p. 1061, fn. omitted.) Former section 14150.1, which was known as the “county option” or the “option plan,” required a county “to pay the state a sum equal to 100 percent of the county’s health care costs (which included both linked and nonlinked individuals) provided in the 1964-1965 fiscal year, with an adjustment for population increase; in return the state would pay the county’s entire cost of medical care.” (County of Sacramento v. Lackner (1979) 97 Cal.App.3d 576, 581 [159 Cal.Rptr. 1] (Lackner).) Under the county option, “the state agreed to assume all county health care costs ... in excess of’ the county’s payment. (Id. at p. 586.) It “made no distinction between ‘linked’ and ‘nonlinked’ persons,” and “simply guaranteed a medical cost ceiling to counties electing to come within the option plan.” {Ibid.) “Any difference in actual operating costs and the limit set by the option provision [was] assumed entirely by the state.” (Preliminary Rep., supra, at p. 10, fn. 2.) Thus, the county option “guarantee^] state participation in the cost of care for medically indigent persons who [were] not otherwise covered by the basic Medi-Cal program or other repayment programs.” (1971 Legis. Analyst’s Rep., supra, at p. 549.) Primarily through the county option, Medi-Cal caused a “significant shift in financing of health care from the counties to the state and federal government. . . . During the first 28 months of the program the state . . . paid approximately $76 million for care of non-Medi-Cal indigents in county hospitals.” (Preliminary Rep., supra, at p. 31.) These state funds paid “costs that would otherwise have been borne by counties through increases in property taxes.” (Legis. Analyst, Rep. to Joint Legis. Budget Com., Analysis of 1974-1975 Budget Bill, Sen. Bill No. 1525 (1973-1974 Reg. Sess.) p. 626 (1974 Legislative Analyst’s Report).) “[F]aced with escalating Medi-Cal costs, the Legislature in 1967 imposed strict guidelines on reimbursing counties electing to come under the ‘option’ plan. ([Former] § 14150.2.) Pursuant to subdivision (c) of [former] section 14150.2, the state imposed a limit on its obligation to pay for medical services to nonlinked persons served by a county within the ‘option’ plan.” (Lackner, supra, 97 Cal.App.3d at p. 589; see also Stats. 1967, ch. 104, § 3, p. 1019; Stats. 1969, ch. 21, § 57, pp. 106-107; 1974 Legis. Analyst’s Rep., supra, at p. 626.) In 1971, the Legislature substantially revised Medi-Cal. It extended coverage to certain noncategorically linked minors and adults “who [were] financially unable to pay for their medical care.” (Legis. Counsel’s Dig., Assem. Bill No. 949, 3 Stats. 1971 (Reg. Sess.) Summary Dig., p. 83; see Stats. 1971, ch. 577, §§ 12, 23, pp. 1110-1111, 1115.) These medically indigent individuals met “the income and resource requirements for aid under [AFDC] but [did] not otherwise qualify[] as a public assistance recipient.” (56 Ops.Cal.Atty.Gen. 568, 569 (1973).) The Legislature anticipated that this eligibility expansion would bring “approximately 800,000 additional medically needy Californians” into Medi-Cal. (Stats. 1971, ch. 577, §56, p. 1136.) The 1971 legislation referred to these individuals as “ ‘[n]oncategorically related needy person[s].’ ” (Stats. 1971, ch. 577, § 23, p. 1115.) Subsequent legislation designated them as “medically indigent person[s]” (MIP’s) and provided them coverage under former section 14005.4. (Stats. 1976, ch. 126, § 7, p. 200; id. at § 20, p. 204.) The 1971 legislation also established a new method for determining each county’s financial contribution to Medi-Cal. The Legislature eliminated the county option by repealing former section 14150.1 and enacting former section 14150. That section specified (by amount) each county’s share of Medi-Cal costs for the 1972-1973 fiscal year and set forth a formula for increasing the share in subsequent years based on the taxable assessed value of certain property. (Stats. 1971, ch. 577, §§ 41, 42, pp. 1131-1133.) For the 1978-1979 fiscal year, the state assumed each county’s share of Medi-Cal costs under former section 14150. (Stats. 1978, ch. 292, § 33, p. 610.) In July 1979, the Legislature repealed former section 14150 altogether, thereby eliminating the counties’ responsibility to share in Medi-Cal costs. (Stats. 1979, ch. 282, § 74, p. 1043.) Thus, in November 1979, when the electorate adopted section 6, “the state was funding Medi-Cal coverage for [MIP’s] without requiring any county financial contribution.” (Kinlaw, supra, 54 Cal.3d at p. 329.) The state continued to provide full funding for MIP medical care through 1982. In 1982, the Legislature passed two Medi-Cal reform bills that, as of January 1, 1983, excluded from Medi-Cal most adults who had been eligible under the MIP category (adult MIP’s or Medically Indigent Adults). (Stats. 1982, ch. 328, §§ 6, 8.3, 8.5, pp. 1574-1576; Stats. 1982, ch. 1594, §§ 19, 86, pp. 6315, 6357; Cooke v. Superior Court (1989) 213 Cal.App.3d 401, 411 [261 Cal.Rptr. 706] (Cooke).) As part of excluding this population from Medi-Cal, the Legislature created the Medically Indigent Services Account (MISA) as a mechanism for “transfer[ing] [state] funds to the counties for the provision of health care services.” (Stats. 1982, ch. 1594, § 86, p. 6357.) Through MISA, the state annually allocated funds to counties based on “the average amount expended” during the previous three fiscal years on MediCal services for county residents who had been eligible as MIP’s. (Stats. 1982, ch. 1594, § 69, p. 6345.) The Legislature directed that MISA funds “be consolidated with existing county health services funds in order to provide health services to low-income persons and other persons not eligible for the Medi-Cal program.” (Stats. 1982, ch. 1594, § 86, p. 6357.) It further provided: “Any person whose income and resources meet the income and resource criteria for certification for [Medi-Cal] services pursuant to Section 14005.7 other than for the aged, blind, or disabled, shall not be excluded from eligibility for services to the extent that state funds are provided.” (Stats. 1982, ch. 1594, § 70, p. 6346.) After passage of the 1982 legislation, San Diego established a county medical services (CMS) program to provide medical care to adult MIP’s. According to San Diego, between 1983 and June 1989, the state fully funded San Diego’s CMS program through MISA. However, for fiscal years 1989-1990 and 1990-1991, the state only partially funded San Diego’s CMS program. For example, San Diego asserts that, in fiscal year 1990-1991, it exhausted state-provided MISA funds by December 24, 1990. Faced with this shortfall, San Diego’s board of supervisors voted in February 1991 to terminate the CMS program unless the state agreed by March 8 to provide full funding for the 1990-1991 fiscal year. After the state refused to provide additional funding, San Diego notified affected individuals and medical service providers that it would terminate the CMS program at midnight on March 19, 1991. The response to the County’s notification ultimately resulted in the unfunded mandate claim now before us. II. Unfunded Mandates Through adoption of Proposition 13 in 1978, the voters added article XIII A to the California Constitution, which “imposes a limit on the power of state and local governments to adopt and levy taxes. [Citation.]” (County of Fresno v. State of California (1991) 53 Cal.3d 482, 486 [280 Cal.Rptr. 92, 808 P.2d 235] (County of Fresno).) The next year, the voters added article XIII B to the Constitution, which “impose[s] a complementary limit on the rate of growth in governmental spending.” (San Francisco Taxpayers Assn. v. Board of Supervisors (1992) 2 Cal.4th 571, 574 [7 Cal.Rptr.2d 245, 828 P.2d 147].) These two constitutional articles “work in tandem, together restricting California governments’ power both to levy and to spend for public purposes.” (City of Sacramento v. State of California (1990) 50 Cal.3d 51, 59, fn. 1 [266 Cal.Rptr. 139, 785 P.2d 522].) Their goals are “to protect residents from excessive taxation and government spending. [Citation.]” (County of Los Angeles v. State of California (1987) 43 Cal.3d 46, 61 [233 Cal.Rptr. 38, 729 P.2d 202] (County of Los Angeles).) Article XIII B of the California Constitution includes section 6, which is the constitutional provision at issue here. It provides in relevant part: “Whenever the Legislature or any state agency mandates a new program or higher level of service on any local government, the state shall provide a subvention of funds to reimburse such local government for the costs of such program or increased level of service, except that the Legislature may, but need not, provide such subvention of funds for the following mandates: [¶] . . . [¶] (c) Legislative mandates enacted prior to January 1, 1975, or executive orders or regulations initially implementing legislation enacted prior to January 1, 1975.” Section 6 recognizes that articles XIII A and XIIIB severely restrict the taxing and spending powers of local governments. (County of Fresno, supra, 53 Cal.3d at p. 487.) Its purpose is to preclude the state from shifting financial responsibility for carrying out governmental functions to local agencies, which are “ill equipped” to assume increased financial responsibilities because of the taxing and spending limitations that articles XIII A and XIII B impose. (County of Fresno, supra, 53 Cal.3d at p. 487; County of Los Angeles, supra, 43 Cal.3d at p. 61.) With certain exceptions, section 6 “[essentially” requires the state “to pay for any new governmental programs, or for higher levels of service under existing programs, that it imposes upon local governmental agencies. [Citation.]” (Hayes v. Commission on State Mandates (1992) 11 Cal.App.4th 1564, 1577 [15 Cal.Rptr.2d 547].) In 1984, the Legislature created a statutory procedure for determining whether a statute imposes state-mandated costs on a local agency within the meaning of section 6. (Gov. Code, § 17500 et seq.). The local agency must file a test claim with the Commission, which, after a public hearing, decides whether the statute mandates a new program or increased level of service. (Gov. Code, §§ 17521, 17551, 17555.) If the Commission finds a claim to be reimbursable, it must determine the amount of reimbursement. (Gov. Code, § 17557.) The local agency must then follow certain statutory procedures to obtain reimbursement. (Gov. Code, § 17558 et seq.) If the Legislature refuses to appropriate money for a reimbursable mandate, the local agency may file “an action in declaratory relief to declare the mandate unenforceable and enjoin its enforcement.” (Gov. Code, § 17612, subd. (c).) If the Commission finds no reimbursable mandate, the local agency may challenge this finding by administrative mandate proceedings under section 1094.5 of the Code of Civil Procedure. (Gov. Code, § 17559.) Government Code section 17552 declares that these provisions “provide the sole and exclusive procedure by which a local agency . . . may claim reimbursement for costs mandated by the state as required by Section 6 III. Administrative and Judicial Proceedings A. The Los Angeles Action On November 23, 1987, the County of Los Angeles (Los Angeles) filed a claim (the Los Angeles action) with the Commission asserting that the exclusion of adult MIP’s from Medi-Cal constituted a reimbursable mandate under section 6. (Kinlaw, supra, 54 Cal.3d at p. 330, fn. 2.) Alameda County subsequently filed a claim on November 30, 1987, but the Commission rejected it because of the pending Los Angeles claim. (Id. at p. 331, fn. 4.) Los Angeles refused to permit Alameda County to join as a claimant, but permitted San Bernardino County to join. (Ibid.) In April 1989, the Commission rejected the Los Angeles claim, finding no reimbursable mandate. (Kinlaw, supra, 54 Cal.3d at p. 330, fn. 2.) It found that the 1982 legislation did not impose on counties a new program or a higher level of service for an existing program because counties had a “pre-existing duty” to provide medical care to the medically indigent under section 17000. TThat section provides in relevant part: “Every county . . . shall relieve and support all incompetent, poor, indigent persons . . . lawfully resident therein, when such persons are not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions.” Section 17000 did not impose a reimbursable mandate under section 6, the Commission further reasoned, because it “was enacted prior to January 1, 1975 . . . .” Finally, the Commission found no mandate because the 1982 legislation “neither established] the level of care to be provided nor . . . define[d] the class of persons determined to be eligible for medical care since these criteria were established by boards of supervisors” pursuant to section 17001. On March 20, 1990, the Los Angeles Superior Court filed a judgment reversing the Commission’s decision and directing issuance of a peremptory writ of mandate. On April 16, 1990, the Commission and the state filed an appeal in the Second District Court of Appeal. (County of Los Angeles v. State of California, No. B049625.) In early 1992, the parties to the Los Angeles action agreed to settle their dispute and to seek dismissal. In April 1992, after learning of this agreement, San Diego sought to intervene. Explaining that it had been waiting for resolution of the action, San Diego requested that the Court of Appeal deny the dismissal request and add (or substitute in) the County as a party. The Court of Appeal did not respond. On December 15, 1992, the parties to the Los Angeles action entered into a settlement agreement that provided for vacation of the superior court judgment and dismissal of the appeal and superior court action. Consistent with the settlement agreement, on December 29, 1992, the Court of Appeal filed an order vacating the superior court judgment, dismissing the appeal, and instructing the superior court to dismiss the action without prejudice on remand. B. The San Diego Action 1. Administrative Attempts to Obtain Reimbursement On March 13, 1991, San Diego submitted an invoice to the State Controller seeking reimbursement of its uncompensated expenditures on the CMS program for fiscal year 1989-1990. The Controller is a member of the Commission. (Gov. Code, § 17525.) On April 12, the Controller returned the invoice “without action,” stating that “[n]o appropriation has been given to this office to allow for reimbursement” of medical costs for adult MIP’s, and noting that litigation was pending regarding the state’s reimbursement obligation. On December 18, 1991, San Diego submitted a similar invoice for the 1990-1991 fiscal year. The state has not acted regarding this second invoice. 2. Court Proceedings Responding to San Diego’s notice of intent to terminate the CMS program, on March 11, 1991, the Legal Aid Society of San Diego filed a class action on behalf of CMS program beneficiaries seeking to enjoin termination of the program. The trial court later issued a preliminary injunction prohibiting San Diego “from taking any action to reduce or terminate” the CMS program. On March 15, 1991, San Diego filed a cross-complaint and petition for writ of mandate under Code of Civil Procedure section 1085 against the state, the Commission, and various state officers. The cross-complaint alleged that, by excluding adult MIP’s from Medi-Cal and transferring responsibility for their medical care to counties* the state had mandated a new program and higher level of service within the meaning of section 6. The cross-complaint further alleged that the state therefore had a duty under section 6 to reimburse San Diego for the entire cost of its CMS program, and that the state had failed to perform its duty. Proceeding from these initial allegations, the cross-complaint alleged causes of action for indeiimification, declaratory and injunctive relief, reimbursement and damages, and writ of mandate. In its first declaratory relief claim, San Diego alleged (on information and belief) that the state contended the CMS program was a nonreimbursable, county obligation. In its claim for reimbursement, San Diego alleged (again on information and belief) that the Commission had “previously denied the claims of other counties, ruling that county medical care programs for [adult MIP’s] are not state-mandated and, therefore, counties are not entitled to reimbursement from the State for the costs of such programs.” “Under these circumstances,” San Diego asserted, “denial of the County’s claim by the Commission . . . is virtually certain and further administrative pursuit of this claim would be a futile act.” For relief, San Diego requested a judgment declaring the following: (1) that the state must fully reimburse San Diego if it “is compelled to provide any CMS Program services to plaintiffs . . . after March 19, 1991”; (2) that section 6 requires the state “to fully fund the CMS Program” (or, alternatively, that the CMS program is discretionary); (3) that the state must pay San Diego for all of its unreimbursed costs for the CMS program during the 1989-1990 and 1990-1991 fiscal years; and (4) that the state shall assume responsibility for operating any court-ordered continuation of the CMS program. San Diego also requested that the court issue a writ of mandamus requiring the state to fulfill its reimbursement obligation. Finally, San Diego requested issuance of preliminary and permanent injunctions to ensure that the state fulfilled its obligations to the County. In April 1991, San Diego determined that it could continue operating the CMS program using previously unavailable general fund revenues. Accordingly, San Diego and plaintiffs settled their dispute, and plaintiffs dismissed their complaint. The matter proceeded solely on San Diego’s cross-complaint. The court issued a preliminary injunction and alternative writ in May 1991. At a hearing on June 25, 1991, the court found that the state had an obligation to fund San Diego’s CMS program, granted San Diego’s request for a writ of mandate, and scheduled an evidentiary hearing to determine damages and remedies. On July 1, 1991, it issued an order reflecting this ruling and granting a peremptory writ of mandate. The writ did not issue, however, because of the pending hearing to determine damages. In December 1992, after an extensive evidentiary hearing and posthearing proceedings on the claim for a peremptory writ of mandate, the court issued a judgment confirming its jurisdiction to determine San Diego’s claim, finding that section 6 required the state to fund the entire cost of San Diego’s CMS program, determining the amount that the state owed San Diego for fiscal years 1989-1990 and 1990-1991, identifying funds available to the state to satisfy the judgment, and ordering issuance of a peremptory writ of mandate. The court also issued a peremptory writ of mandate directing the state and various state officers to comply with the judgment. The Court of Appeal affirmed the judgment insofar as it provided that section 6 requires the state to fund the CMS program. The Court of Appeal also affirmed the trial court’s finding that the state had required San Diego to spend at least $41 million on the CMS program in fiscal years 1989-1990 and 1990-1991. However, the Court of Appeal reversed those portions of the judgment determining the final reimbursement amount and specifying the state funds from which the state was to satisfy the judgment. It remanded the matter to the Commission to determine the reimbursement amount and appropriate statutory remedies. We then granted the state’s petition for review. IV. Superior Court Jurisdiction Before reaching the merits of the appeal, we must address the state’s assertion that the superior court lacked jurisdiction to hear San Diego’s mandate claim. According to the state, in Kinlaw, supra, 54 Cal.3d 326, we “unequivocally held that the orderly determination of [unfunded] mandate questions demands that only one claim on any particular alleged mandate be entertained by the courts at any given time.” Thus, if a test claim is pending, “other potential claims must be held in abeyance . . . .” Applying this principle, the state asserts that, since “the test claim litigation was pending” in the Los Angeles action when San Diego filed its cross-complaint seeking mandamus relief, “the superior court lacked jurisdiction from the outset, and the resulting judgment is a nullity. That defect cannot be cured by the settlement of the test claim, which occurred after judgment was entered herein.” In Kinlaw, we held that individual taxpayers and recipients of government benefits lack standing to enforce section 6 because the applicable administrative procedures, which “are the exclusive means” for determining and enforcing the state’s section 6 obligations, “are available only to local agencies and school districts directly affected by a state mandate . . . .” (Kinlaw, supra, 54 Cal.3d at p. 328.) In reaching this conclusion, we explained that the reimbursement right under section 6 “is a right given by the Constitution to local agencies, not individuals either as taxpayers or recipients of government benefits and services.” (Id. at p. 334.) We concluded that “[njeither public policy nor practical necessity compels creation of a judicial remedy by which individuals may enforce the right of the county to such revenues.” (Id. at p. 335.) In finding that individuals do not have standing to enforce the section 6 rights of local agencies, we made several observations in Kinlaw pertinent to operation of the statutory process as it applies to entities that do have standing. Citing Government Code section 17500, we explained that “the Legislature enacted comprehensive administrative procedures for resolution of claims arising out of section 6 . . . because the absence of a uniform procedure had resulted in inconsistent rulings on the existence of state mandates, unnecessary litigation, reimbursement delays, and, apparently, resultant uncertainties in accommodating reimbursement requirements in the budgetary process.” (Kinlaw, supra, 54 Cal.3d at p. 331.) Thus, the governing statutes “establish[] procedures which exist for the express purpose of avoiding multiple proceedings, judicial and administrative, addressing the same claim that a reimbursable state mandate has been created.” (Id. at p. 333.) Specifically, “[t]he legislation establishes a test-claim procedure to expeditiously resolve disputes affecting multiple agencies . . . .” (Id. at p. 331.) Describing the Commission’s application of the test-claim procedure to claims regarding exclusion of adult MIP’s from Medi-Cal, we observed: “The test claim by the County of Los Angeles was filed prior to that proposed by Alameda County. The Alameda County claim was rejected for that reason. (See [Gov. Code,] § 17521.) Los Angeles County permitted San Bernardino County to join in its claim which the Commission accepted as a test claim intended to resolve the [adult MIP exclusion] issues .... Los Angeles County declined a request from Alameda County that it be included in the test claim . . . .” (Id. at p. 331, fn. 4.) Consistent with our observations in Kinlaw, we here agree with the state that the trial court should not have proceeded to resolve San Diego’s claim for reimbursement under section 6 while the Los Angeles action was pending. A contrary conclusion would undermine one of “the express purpose[s]” of the statutory procedure: to “avoid[] multiple proceedings . . . addressing the same claim that a reimbursable state mandate has been created.” (Kinlaw, supra, 54 Cal.3d at p. 333.) However, we reject the state’s assertion that the error was jurisdictional. The power of superior courts to perform mandamus review of administrative decisions derives in part from article VI, section 10 of the California Constitution. (Bixby v. Pierno (1971) 4 Cal.3d 130, 138 [93 Cal.Rptr. 234, 481 P.2d 242]; Lipari v. Department of Motor Vehicles (1993) 16 Cal.App.4th 667, 672 [20 Cal.Rptr.2d 246].) That section gives “[t]he Supreme Court, courts of appeal, [and] superior courts . . . original jurisdiction in proceedings for extraordinary relief in the nature of mandamus ....’’ (Cal. Const., art. VI, § 10.) “The jurisdiction thus vested may not lightly be deemed to have been destroyed.” (Garrison v. Rourke (1948) 32 Cal.2d 430, 435 [196 P.2d 884], overruled on another ground in Keane v. Smith (1971) 4 Cal.3d 932, 939 [95 Cal.Rptr. 197, 485 P.2d 261].) “While the courts are subject to reasonable statutory regulation of procedure and other matters, they will maintain their constitutional powers in order effectively to function as a separate department of government. [Citations.] Consequently an intent to defeat the exercise of the court’s jurisdiction will not be supplied by implication.” (Garrison, supra, at p. 436.) Here, we find no statutory provision that either “expressly provide[s]” (id. at p. 435) or otherwise “clearly indicate[s]” (id. at p. 436) that the Legislature intended to divest all courts other than the court hearing the test claim of their mandamus jurisdiction. Rather, following Dowdall v. Superior Court (1920) 183 Cal. 348 [191 P. 685] (Dowdall), we interpret the governing statutes as simply vesting primary jurisdiction in the court hearing the test claim. In Dowdall, we determined the jurisdictional effect of Code of Civil Procedure former section 1699 on actions to settle the account of trustees of a testamentary trust. Code of Civil Procedure former section 1699 provided in part: “Where any trust has been created by or under any will to continue after distribution, the Superior Court shall not lose jurisdiction of the estate by final distribution, but shall retain jurisdiction thereof for the purpose of the settlement of accounts under the trust.” (Stats. 1889, ch. 228, § 1, p. 337.) We explained that, under this section, “the superior court, sitting in probate upon the distribution of an estate wherein the will creates a trust, retain[ed] jurisdiction of the estate for the purpose of the settlement of the accounts under the trust.” (Dowdall, supra, 183 Cal. at p. 353.) However, we further observed that “the superior court of each county in the state has general jurisdiction in equity to settle trustees’ accounts and to entertain actions for injunctions. This jurisdiction is, in a sense, concurrent with that of the superior court, which, by virtue of the decree of distribution, has jurisdiction of a trust created by will. The latter, however, is the primary jurisdiction, and if a bill in equity is filed in any other superior court for the purpose of settling the account of such trustee, that court, upon being informed of the jurisdiction of the court in probate and that an account is to be or has been filed therein for settlement, should postpone the proceeding in its own case and allow the account to be settled by the court having primary jurisdiction thereof.” {Ibid.) Similarly, we conclude that, under the statutes governing determination of unfunded mandate claims, the court hearing the test claim has primary jurisdiction. Thus, if an action asserting the same unfunded mandate claim is filed in any other superior court, that court, upon being informed of the pending test claim, should postpone the proceeding before it and allow the court having primary jurisdiction to determine the test claim. However, a court’s erroneous refusal to stay further proceedings does not render those further proceedings void for lack of jurisdiction. As we explained in Dowdall, a court that refuses to defer to another court’s primary jurisdiction “is not without jurisdiction.” (Dowdall, supra, 183 Cal. at p. 353.) Accordingly, notwithstanding pendency of the Los Angeles action, the trial court here did not lack jurisdiction to determine San Diego’s mandamus petition. (See Collins v. Ramish (1920) 182 Cal. 360, 366-369 [188 P. 550] [although trial court erred in refusing to abate action because of former action pending, new trial was not warranted on issues that the trial court correctly decided]; People ex rel. Garamendi v. American Autoplan, Inc. (1993) 20 Cal.App.4th 760, 772 [25 Cal.Rptr.2d 192] (Garamendi) [“rule of exclusive concurrent jurisdiction is not ‘jurisdictional’ in the sense that failure to comply renders subsequent proceedings void”]; Stearns v. Los Angeles City School Dist. (1966) 244 Cal.App.2d 696, 718 [53 Cal.Rptr. 482, 21 A.L.R.3d 164] [where trial court errs in failing to stay proceedings in deference to jurisdiction of another court, reversal would be frivolous absent errors regarding the merits].) The trial court’s failure to defer to the primary jurisdiction of the court hearing the Los Angeles action did not prejudice the state. Contrary to the state’s assertion, the trial court did not “usurp” the Commission’s “authority to determine, in the first place, whether or not legislation creates a mandate.” The Commission had already exercised that authority in the Los Angeles action. Moreover, given the settlement of the Los Angeles action, which included vacating the judgment in that action, the trial court’s exercise of jurisdiction here did not result in one of the principal harms that the statutory procedure seeks to prevent: multiple decisions regarding an unfunded mandate question. Finally, the lack of an administrative record specifically relating to San Diego’s claim did not prejudice the state because the threshold determination of whether a statute imposes a state mandate is an issue of law. (County of Fresno v. Lehman (1991) 229 Cal.App.3d 340, 347 [280 Cal.Rptr. 310].) To the extent that an administrative record was necessary, the record developed in the Los Angeles action could have been submitted to the trial court. (See Los Angeles Unified School Dist. v. State of California (1988) 199 Cal.App.3d 686, 689 [245 Cal.Rptr. 140].) We also find that, on the facts of this case, San Diego’s failure to submit a test claim to the Commission before seeking judicial relief did not affect the superior court’s jurisdiction. Ordinarily, counties seeking to pursue an unfunded mandate claim under section 6 must exhaust their administrative remedies. (Central Delta Water Agency v. State Water Resources Control Bd. (1993) 17 Cal.App.4th 621, 641 [21 Cal.Rptr.2d 453]; County of Contra Costa v. State of California (1986) 177 Cal.App.3d 62, 73-77 [222 Cal.Rptr. 750] (County of Contra Costa).) However, counties may pursue section 6 claims in superior court without first resorting to administrative remedies if they “can establish an exception to” the exhaustion requirement. (County of Contra Costa, supra, 177 Cal.App.3d at p. 77.) The futility exception to the exhaustion requirement applies if a county can “state with assurance that the [Commission] would rule adversely in its own particular case. [Citations.]” (Lindeleaf v. Agricultural Labor Relations Bd. (1986) 41 Cal.3d 861, 870 [226 Cal.Rptr. 119, 718 P.2d 106]; see also County of Contra Costa, supra, 177 Cal.App.3d at pp. 77-78.) We agree with the trial court and the Court of Appeal that the futility exception applied in this case. As we have previously noted, San Diego invoked this exception by alleging in its cross-complaint that the Commission’s denial of its claim was “virtually certain” because the Commission had “previously denied the claims of other counties, ruling that county medical care programs for [adult MIP’s] are not state-mandated and, therefore, counties are not entitled to reimbursement . . . .” Given that the Commission rejected the Los Angeles claim (which alleged the same unfunded mandate claim that San Diego alleged) and appealed the judicial reversal of its decision, the trial court correctly determined that further attempts to seek relief from the Commission would have been futile. Therefore, we reject the state’s jurisdictional argument and proceed to the merits of the appeal. V. Existence of a Mandate Under Section 6 In determining whether there is a mandate under section 6, we turn to our decision in Lucia Mar Unified School Dist. v. Honig (1988) 44 Cal.3d 830 [244 Cal.Rptr. 677, 750 P.2d 318] (Lucia Mar). There, we discussed section 6’s application to Education Code section 59300, which “requires a school district to contribute part of the cost of educating pupils from the district at state schools for the severely handicapped.” (Lucia Mar, supra, at p. 832.) Before 1979, the Legislature had statutorily required school districts “to contribute to the education of pupils from the districts at the state schools [citations] . . . .” (Id. at pp. 832-833.) The Legislature repealed the statutory requirements in 1979 and, on July 12, 1979, the state assumed full-funding responsibility. (Id. at p. 833.) On July 1, 1980, when section 6 became effective, the state still had full-funding responsibility. On June 28, 1981, Education Code section 59300 took effect. (Lucia Mar, supra, at p. 833.) Various school districts filed a claim seeking reimbursement under section 6 for the payments that Education Code section 59300 requires. The Commission denied the claim, finding that the statute did not impose on the districts a new program or higher level of service. The trial court and Court of Appeal agreed, the latter “reasoning that a shift in the funding of an existing program is not a new program or a higher level of service” under section 6. (Lucia Mar, supra, 44 Cal.3d at p. 834.) We reversed, finding that a contrary result would “violate the intent underlying section 6 ... .” (Lucia Mar, supra, 44 Cal.3d at p. 835.) That section “was intended to preclude the state from shifting to local agencies the financial responsibility for providing public services in view of the[] restrictions on the taxing and spending power of the local entities” that articles XIII A and XIII B of the California Constitution imposed. (Lucia Mar, supra, at pp. 835-836.) “The intent of the section would plainly be violated if the state could, while retaining administrative control of programs it has supported with state tax money, simply shift the cost of the programs to local government on the theory that the shift does not violate section 6 . . . because the programs are not ‘new.’ Whether the shifting of costs is accomplished by compelling local governments to pay the cost of entirely new programs created by the state, or by compelling them to accept financial responsibility in whole or in part for a program which was funded entirely by the state before the advent of article XIIIB, the result seems equally violative of the fundamental purpose underlying section 6 . . . .” (Id. at p. 836, italics added, fh. omitted.) We thus concluded in Lucia Mar “that because [Education Code] section 59300 shifts partial financial responsibility for the support of students in the state-operated schools from the state to school districts—an obligation the school districts did not have at the time article XIII B was adopted—it calls for [the school districts] to support a ‘new program’ within the meaning of section 6.” (Ibid., fn. omitted.) The similarities between Lucia Mar and the case before us “are striking. In Lucia Mar, prior to 1979 the state and county shared the cost of educating handicapped children in state schools; in the present case from 1971-197[8] the state and county shared the cost of caring for [adult MIP’s] under the Medi-Cal program. . . . [F]ollowing enactment of [article XIII A], the state took full responsibility for both programs.” (Kinlaw, supra, 54 Cal.3d at p. 353 (dis. opn. of Broussard, J.).) As to both programs, the Legislature cited adoption of article XIII A of the California Constitution, and specifically its effect on tax revenues, as the basis for the state’s assumption of full funding responsibility. (Stats. 1979, ch. 237, § 10, p. 493; Stats. 1979, ch. 282, § 106, p. 1059.) “Then in 1981 (for handicapped children) and 1982 (for [adult MIP’s]), the state sought to shift some of the burden back to the counties.” (Kinlaw, supra, 54 Cal.3d at p. 353 (dis. opn. of Broussard, J.).) Adopting the Commission’s analysis in the Los Angeles action, the state nevertheless argues that Lucia Mar “is inapposite.” The school program at issue in Lucia Mar “had been wholly operated, administered and financed by the state” and “was unquestionably a ‘state program.’ ” “ ‘In contrast,’ ” the state argues, “ ‘the program here has never been operated or administered by the State of California. The counties have always borne legal and financial responsibility for’ ” it under section 17000 and its predecessors. The courts have interpreted section 17000 as “impos[ing] upon counties a duty to provide hospital and medical services to indigent residents. [Citations.]” (Board of Supervisors v. Superior Court (1989) 207 Cal.App.3d 552, 557 [254 Cal.Rptr. 905].) Thus, the state argues, the source of San Diego’s obligation to provide medical care to adult MIP’s is section 17000, not the 1982 legislation. Moreover, because the Legislature enacted section 17000 in 1965, and section 6 does not apply to “mandates enacted prior to January 1, 1975,” there is no reimbursable mandate. Finally, the state argues that, because section 17001 give counties “complete discretion” in setting eligibility and service standards under section 17000, there is no mandate. A contrary conclusion, the state asserts, “would erroneously expand the definition of what constitutes a ‘new program’ under” section 6. As we explain, we reject these arguments. A. The Source and Existence of San Diego’s Obligation 1. The Residual Nature of the Counties’ Duty Under Section 17000 The state’s argument that San Diego’s obligation to provide medical care to adult MIP’s predates the 1982 legislation contains numerous errors. First, the state misunderstands San Diego’s obligation under section 17000. That section creates “the residual fund” to sustain indigents “who cannot qualify . . . under any specialized aid programs.” (Mooney, supra, 4 Cal.3d at p. 681, italics added; see also Board of Supervisors v. Superior Court, supra, 207 Cal.App.3d at p. 562; Boehm v. Superior Court (1986) 178 Cal.App.3d 494, 499 [223 Cal.Rptr. 716] [general assistance “is a program of last resort”].) By its express terms, the statute requires a county to relieve and support indigent persons only “when such persons are not supported and relieved by their relatives or friends, by their own means, or by state hospitals or other state or private institutions.” (§ 17000.) “Consequently, to the extent that the state or federal governments provide[d] care for [adult MIP’s], the [C]ounty’s obligation to do so [was] reduced . . . .” (Kinlaw, supra, 54 Cal.3d at p. 354, fn. 14 (dis. opn. of Broussard, J.).) As we have explained, the state began providing adult MIP’s with medical care under Medi-Cal in 1971. Although it initially required counties to contribute generally to the costs of Medi-Cal, it did not set forth a specific amount for coverage of MIP’s. The state was primarily responsible for the costs of the program, and the counties were simply required to contribute funds to defray the state’s costs. Beginning with the 1978-1979 fiscal year, the state paid all costs of the Medi-Cal program, including the cost of medical care for adult MIP’s. Thus, when section 6 was adopted in November 1979, to the extent that Medi-Cal provided medical care to adult MIP’s, San Diego bore no financial responsibility for these health care costs. The California Attorney General has expressed a similar understanding of Medi-Cal’s effect on the counties’ medical care responsibility under section 17000. After the 1971 extension of Medi-Cal coverage to MIP’s, Fresno County sought an opinion regarding the scope of its duty to provide medical care under section 17000. It asserted that the 1971 repeal of former section 14108.5, which declared the Legislature’s concern with the counties’ problems in caring for indigents not eligible for Medi-Cal, evidenced a legislative intent to preempt the field of providing health services. (56 Ops.Cal.Atty.Gen., supra, at p. 571.) The Attorney General disagreed, concluding that the 1971 change “did not alter the duty of the counties to provide medical care to those indigents not eligible for Medi-Cal.” (Id. at p. 569.) The Attorney General explained: “The statement of concern acknowledged the obligation of counties to continue to provide medical assistance under section 17000; the removal of the statement of concern was not accompanied by elimination of such duty on the part of the counties, except as the addition of [MIP’s] to the Medi-Cal program would remove the burden on the counties to provide medical care for such persons.” (Id. at p. 571, italics added.) Indeed, the Legislature’s statement of intent in an uncodified section of the 1982 legislation excluding adult MIP’s from Medi-Cal suggests that it also shared our understanding of section 17000. Section 8.3 of the 1982 Medi-Cal revisions expressly declared the Legislature’s intent “[i]n eliminating [M]edically [I]ndigent [A]dults from the Medi-Cal program . . . .” (Stats. 1982, ch. 328, § 8.3, p. 1575; Stats. 1982, ch. 1594, § 86, p. 6357.) It stated in part: “It is further the intent of the Legislature to provide counties with as much flexibility as possible in organizing county health services to serve the population being transferred.” (Stats. 1982, ch. 328, § 8.3, p. 1576; Stats. 1982, ch. 1594, § 86, p. 6357, italics added.) If, as the state contends, counties had always been responsible under section 17000 for the medical care of adult MIP’s, the description of adult MIP’s as “the population being transferred” would have been inaccurate. By so describing adult MIP’s, the Legislature indicated its understanding that counties did not have this responsibility while adult MIP’s were eligible for Medi-Cal. These sources fully support our rejection of the state’s argument that the 1982 legislation did not impose a mandate because, under section 17000, counties had always borne the responsibility for providing medical care to adult MIP’s. 2. The State’s Assumption of Full Funding Responsibility for Providing Medical Care to Adult MIP’s Under Medi-Cal To support its argument that it never relieved counties of their obligation under section 17000 to provide medical care to adult MIP’s, the state characterizes as “temporary” the Legislature’s assumption of full-funding responsibility for adult MIP’s. According to the state, “any ongoing responsibility of the county was, at best, only temporarily, partially, alleviated (and never supplanted).” The state asserts that the Court of Appeal thus “erred by focusing on one phase in th[e] shifting pattern of arrangements” for funding indigent health care, “a focus which led to a myopic conclusion that the state alone is forever responsible for funding the health care for” adult MIP’s. A comparison of the 1978 and 1979 statutes that eliminated the counties’ share of Medi-Cal costs refutes the state’s claim. The Legislature expressly limited the effect of the 1978 legislation to one fiscal year, providing that the state “shall pay” each county’s Medi-Cal cost share “for the period from July 1, 1978, to June 30, 1979.” (Stats. 1978, ch. 292, § 33, p. 610.) The Legislative Counsel’s Digest explained that this section would require the state to pay “[a]ll county costs for Medi-Cal” for “the 1978-79 fiscal year only.” (Legis. Counsel’s Dig., Sen. Bill No. 154, 4 Stats. 1978 (Reg. Sess.), Summary Dig., p. 71.) The digest further explained that the purpose of the bill containing this section was “the partial relief of local government from the temporary difficulties brought about by the approval of Proposition 13.” (Id. at p. 70, italics added.) Clearly, the Legislature knew how to include words of limitation when it intended the effects of its provisions to be temporary. By contrast, the 1979 legislation contains no such limiting language. It simply provided: “Section 14150 of the Welfare and Institutions Code is repealed.” (Stats. 1979, ch. 282, § 74, p. 1043.) In setting forth the need to enact the legislation as an urgency statute, the Legislature explained: “The adoption of Article XIII A . . . may cause the curtailment or elimination of programs and services which are vital to the state’s public health, safety, education, and welfare. In order that such services not be interrupted, it is necessary that this act take effect immediately.” (Stats. 1979, ch. 282, § 106, p. 1059.) In describing the effect of this legislation, the Legislative Counsel first explained that, “[u]nder existing law, the counties pay a specified annual share of the cost of’ Medi-Cal. (Legis. Counsel’s Dig., Assem. Bill No. 8, 4 Stats. 1979 (Reg. Sess.), Summary Dig., p. 79.) Referring to the 1978 legislation, it further explained that “[f|or the 1978-79 fiscal year only, the state pays . . . HD . . . [a]ll county costs for Medi-Cal . . . .” (Ibid.) The 1979 legislation, the digest continued, “provid[ed] for state assumption of all county costs of Medi-Cal.” (Ibid.) We find nothing in the 1979 legislation or the Legislative Counsel’s summary indicating a legislative intent to eliminate the counties’ cost share of Medi-Cal only temporarily. The state budget process for the 1980r 1981 fiscal year confirms that the Legislature’s assumption of all Medi-Cal costs was not viewed as “temporary.” In the summary of his proposed budget, then Governor Brown described Assembly Bill No. 8, 1981-1982 Regular Session, generally as “a long-term local financing measure” (Governor’s Budget for 1980-1981 as submitted to Legislature (1979-1980 Reg. Sess.) Summary of Local Government Fiscal Relief, p. A-30) through which “[t]he total cost of [the MediCal] program was permanently assumed by the State . . . .” (Id. at p. A-32, italics added.) Similarly, in describing to the Joint Legislative Budget Committee the Medi-Cal funding item in the proposed budget, the Legislative Analyst explained: “Item 287 includes the state cost of ‘buying out’ the county share of Medi-Cal expenditures. Following passage of Proposition 13, [Senate Bill No.] 154 appropriated $418 million to relieve counties of all fiscal responsibility for Medi-Cal program costs. Subsequently, [Assembly Bill No.] 8 was enacted, which made permanent state assumption of county Medi-Cal costs.” (Legis. Analyst, Rep. to Joint Legis. Budget Com., Analysis of 1980-1981 Budget Bill, Assem. Bill No. 2020 (1979-1980 Reg. Sess.) at p. 721, italics added.) Thus, the state errs in asserting that the 1979 legislation eliminated the counties’ financial support of Medi-Cal “only temporarily.” 3. State Administration of Medical Care for Adult MIP’s Under Medi-Cal The state argues that, unlike the school program before us in Lucia Mar, supra, 44 Cal.3d 830, which “had been wholly operated, administered and financed by the state,” the program for providing medical care to adult MIP’s “ ‘has never been operated or administered by’ ” the state. According to the state, Medi-Cal was simply a state “reimbursement program” for care that section 17000 required counties to provide. The state is incorrect. One of the legislative goals of Medi-Cal was “to allow eligible persons to secure basic health care in the same manner employed by the public generally, and without discrimination or segregation based purely on their economic disability.” (Stats. 1966, Second Ex. Sess. 1965, ch. 4, § 2, p. 104.) “In effect, this meant that poorer people could have access to a private practitioner of their choice, and not be relegated to a county hospital program.” (California Medical Assn. v. Brian (1973) 30 Cal.App.3d 637, 642 [106 Cal.Rptr. 555].) Medi-Cal “provided for reimbursement to both public and private health care providers for medical services rendered.” (Lackner, supra, 97 Cal.App.3d at p. 581.) It further directed that, “[i]nsofar as practical,” public assistance recipients be afforded “free choice of arrangements under which they shall receive basic health care.” (Stats. 1966, Second Ex. Sess. 1965, ch. 4, § 2, p. 115.) Finally, since its inception, Medi-Cal has permitted county boards of supervisors to “prescribe rules which authorize the county hospital to integrate its services with those of other hospitals into a system of community service which offers free choice of hospitals to those requiring hospital care. The intent of this section is to eliminate discrimination or segregation based on economic disability so that the county hospital and other hospitals in the community share in providing services to paying patients and to those who qualify for care in public medical care programs.” (§ 14000.2.) Thus, “Medi-Cal eligibles were to be able to secure health care in the same manner employed by the general public (i.e., in the private sector or at a county facility).” (1974 Legis. Analyst’s Rep., supra, at p. 625; see also Preliminary Rep., supra, at p. 17.) By allowing eligible persons “a choice of medical facilities for treatment,” Medi-Cal placed county health care providers “in competition with private hospitals.” (Hall, supra, 23 Cal.App.3d at p. 1061.) Moreover, administration of Medi-Cal over the years has been the responsibility of various state departments and agencies. (§§ 10720-10721, 14061-14062, 14105, 14203; Belshé, supra, 13 Cal.4th at p. 751; Morris, supra, 67 Cal.2d at p. 741; Summary of Major Events, supra, at pp. 2-3, 15.) Thus, “[i]n adopting the Medi-Cal program the state Legislature, for the most part, shifted indigent medical care from being a county responsibility to a State responsibility under the Medi-Cal program. [Citation.]” (Bay General Community Hospital v. County of San Diego (1984) 156 Cal.App.3d 944, 959 [203 Cal.Rptr. 184] (Bay General); see also Preliminary Rep., supra, at p. 18 [with certain exceptions, Medi-Cal “shifted to the state” the responsibility for administration of the medical care provided to eligible persons].) We therefore reject the state’s assertion that, while Medi-Cal covered adult MIP’s, county facilities were the sole providers of their medical care, and counties both operated and administered the program that provided that care. The circumstances we have discussed readily distinguish this case from County of Los Angeles v. Commission on State Mandates (1995) 32 Cal.App.4th 805 [38 Cal.Rptr.2d 304], on which the state relies. There, the court rejected the claim that Penal Code section 987.9, which required counties to provide criminal defendants with certain defense funds, imposed an unfunded state mandate. Los Angeles filed the claim after the state, which had enacted appropriations between 1977 and 1990 “to reimburse counties for their costs under” the statute, made no appropriation for the 1990-1991 fiscal year. (County of Los Angeles v. Commission on State Mandates, supra, at p. 812.) In rejecting the claim, the court first held that there was no state mandate because Penal Code section 987.9 merely implemented the requirements of federal law. (County of Los Angeles v. Commission on State Mandates, supra, at pp. 814-816.) Thus, the court stated, “[a]ssuming, arguendo, the provisions of [Penal Code] section 987.9 [constituted] a new program” under section 6, there was no state mandate. (County of Los Angeles v. Commission on State Mandates, supra, at p. 818.) Here, of course, it is unquestionably the state that has required San Diego to provide medical care to indigent persons. In dictum, the court also rejected the argument that, under Lucia Mar, supra, 44 Cal.3d 830, the state’s “decision not to reimburse the counties for their programs under [Penal Code] section 987.9” imposed a new program by shifting financial responsibility for the program to counties. (County of Los Angeles v. Commission on State Mandates, supra, 32 Cal.App.4th at p. 817.) The court explained: “In contrast [to Lucia Mar], the program here has never been operated or administered by the State of California. The counties have always borne legal and financial responsibility for implementing the procedures under [Penal Code] section 987.9. The state merely reimbursed counties for specific expenses incurred by the counties in their operation of a program for which they had a primary legal and financial responsibility.