Just navigating the paperwork maze in qualifying for Medi-Care or the Medically Indigent Adult program is daunting for poor people who probably don't have a computer or the skills to use one.
To qualify for Medi-Cal, patients have to prove their citizenship, said Debra Riordan, legislative analyst for the Central Valley Health Policy Institute at California State University, Fresno. But birth certificates may be in another state, and getting a copy can be a challenge.
"It's difficult when there are families of mixed immigration status," she said. "One child might be a legal citizen and another illegal, and the parents are undocumented. It's a problem unique to the valley."
Those who can't prove they're a U.S. citizen are ineligible for Medi-Cal.
The Medically Indigent Adult application form in Stanislaus County is five pages, and instructions are four pages.
"If you are poor, it's pretty hard to do this," said Dr. Del Morris, medical director of the Stanislaus County clinics. It can take two weeks to get the paperwork done, he said.
"People on the front lines work very hard to get them qualified, but there is a bureaucracy, red tape, and people have to cooperate," Morris said.
"They bring back the papers, but their life is in chaos, they are using public transportation. An appointment is a half a day, and they have to take their children along, or find someone they trust to take care of them."
Patients churn in and out of the system, creating mounds of paperwork and not getting consistent care, Riordan said.
"The system is complicated, the paperwork is bewildering. There are enrollment specialists out there, but if you have no way to access the system, no computer, it's difficult," she said.