Farmworkers in a remote corner of Northern California say they have never heard of the state's efforts to expand health insurance to undocumented residents.
SMITH RIVER, California – Álvaro Urrea Olivares has a soft, pleasant voice. At 45, his weathered hands reveal decades of work in the lily fields that drive the local economy in this small community in the far north of California.
Smith River is not just rural, residents say, it's remote, rural, California's last frontier, and it's here that the state's plan to expand access to health care to all residents is being tested.
“I don’t have a house. Other people help me here. They help me find work; they give me food and I sleep in my car. It’s not as bad as those who sleep outdoors,” explains Urrea, nicknamed Caballo, pointing to an abandoned BMW.
Packed with blankets and personal belongings, the car is parked amid a row of trailers housing about 50 farmworkers and their families. The vast majority are from Veracruz, Jalisco or, in Urrea’s case, Guanajuato. At the park entrance is a yellow sign that reads: “Welcome to Smith River. Easter Lily Capital of the World.”
In years past, migrants — many of them undocumented — would come and go with the lily harvest, returning to Mexico in the fall and then returning to Smith River in the spring to plant. But as border restrictions tightened, many remained in what has become a permanent community. Between planting and harvesting, residents turn to day jobs to survive.
“It’s expensive here,” Urrea continues in Spanish. “When people don’t have work, they can’t pay the rent. I’ve been sleeping in this car for three years.”
Manuel Ortiz reports on the lack of information about Medi-Cal eligibility available to farmworkers in Smith River, Del Norte County, for the radio show Por la Libre. (Spanish only. Click here.) Click here to read an English transcript).
Starting January 1, California made Medi-Cal, the state’s version of Medicaid, available to all residents regardless of immigration status. At the same time, it has also dramatically expanded Medi-Cal services to include help with things like nutrition, mental health and housing support, among other needs.
But news of the expansion has yet to reach farmworkers here, many of whom are uninsured and would potentially qualify.
“Don’t get sick here”
“I got pretty sick a few years ago. They wouldn’t cover my medications,” Urrea says, referring to the clinic she went to for treatment in Crescent City, 15 miles south. “Nowadays I don’t have much work and I don’t have money to pay. So I buy pills at the store when I get sick.”
Pills in the store. It's a phrase you hear from other trailer park residents when asked about their health.
“I don’t know how to get insurance,” says Tino (who did not want to give his last name). Tino, who is in his 30s, has lived here in one of the trailers for two years. “I got sick three months ago and I just took some pills.” He adds: “We are Latinos, immigrants… It’s not easy for us to get insurance.”
Smith River is located in the northwestern corner of Del Norte County, a sparsely populated corner of Northern California sandwiched between Humboldt County to the south, the Oregon border to the north, vast forests to the east, and the Pacific to the west. Latinos here make up only 20 percent of the overall population (which is mostly white, with a significant Native American presence), though they make up the vast majority of the region’s agricultural workforce.
And as in many communities here, there is (at least among the farmworkers interviewed for this article) an instinctive distrust of government. Don’t depend on the state. If you get sick, it’s up to you. Or, as one resident commented, “You better not get sick here.”
Spreading the word
Kathleen Moreno directs outreach and enrollment for Open Door Community Health Center, which operates 12 clinics in Del Norte and neighboring Humboldt counties.
“There are people who have not had access to medical care since they have been here,” she says, “and so some of their health conditions are terrifying and out of control.”
As a federally qualified health center (FQHC), Open Door is one of nearly three dozen organizations in 48 of California’s 58 counties that are part of the Navigators Health Enrollment Project, launched by the California Department of Health Care Services (DHCS) to help bring information about Medi-Cal eligibility to local communities. The initiative will run through mid-2026.
Doing so in places like Del Norte, where distances are long and resources are few, is not without its challenges.
“There is no easy channel of communication up here,” said Moreno, who lives in Crescent City. There are no local Spanish-language radio stations, no newspapers, and Internet access is limited in some areas, he said. “It’s been like this since I’ve lived here for 18 years.”
Open Door relies on informational posts on platforms like Facebook, presentations at local health fairs and community events, and community health workers, also known as Latino Health Coordinators, of which two cover Del Norte and three for all of Humboldt.
Moreno oversees their work. “Their success has been largely based on trust and word-of-mouth referrals… once a family realizes they can trust our coordinators, they tell their family.”
But going directly to the farms has been a challenge, Moreno says. “Obviously, we can’t stop work and the farm owners weren’t thrilled about having people on the farms. So, we posted in the break rooms and brought a healthy snack so everyone could come in and chat. But lunch breaks are short — half an hour — and then it’s back to work.”
Open Door also scanned patient records from 2022 and 2023 to see who had previously accessed care but was uninsured. These individuals were enrolled in emergency Medi-Cal and are now eligible for full-scope Medi-Cal under the current expansion, though many may not be aware of this fact, Moreno acknowledges.
Another key barrier is the lack of public transportation. The closest clinic to Smith River is in Crescent City. For serious medical needs, patients must travel to Redding, a four-hour drive south, or San Francisco, a six-hour drive.
There’s also a shortage of providers. “It’s really hard to find providers who want to live and work in Crescent City. Sometimes we find a great provider and they stay. Most of the time, they leave,” Moreno says, noting that there’s only one ophthalmologist in Crescent City who sees Medi-Cal patients, and his waiting list is at capacity.
The policy increases mistrust as undocumented residents have to weigh their health care needs against fears of stirring up anti-immigrant sentiment and jeopardizing their path to citizenship or legal residency by accessing public benefits, which under the previous administration could be grounds for deportation.
“That’s a real concern for people,” Moreno says. “We heard from one person who said, ‘If my information gets out and I get deported, at least I’ll have access to health care.’”
“You have to take care of yourself”
Back in Smith River, trailer park residents were sometimes unaware and uncertain about the current Medi-Cal expansion.
“I had never heard of Medi-Cal,” says Alberto Hernandez, a native of Chiapas who has lived here for the past 11 months. When asked what he does when he gets sick, he shrugs. “I don’t know… it’s very expensive here. Maybe go back to Mexico.”
Anancio Hernandez works as a local chef. “A month or two ago I had some pain. But I kept working, even though I was sick,” he says. “I don’t have insurance, so I didn’t go to the hospital.” Asked if he would sign up for Medi-Cal if given the chance, he nodded. “I’ll go look into it to see if this opportunity exists.”
For his part, Urrea shares that his mother, who also lives in Del Norte, was recently hospitalized after suffering a stroke. She lost sight in her left eye, he says. Like him, she does not have insurance.
And while his affection for the community and the region is clear (he's eager to show visitors the local beaches, where he says he sometimes goes to clear his head), he is clear-eyed about the challenges.
“When you're dying, you have to take care of yourself. That's the bad thing about it.”
Additional information by Manuel Ortiz.
This is the second in a series looking at Medi-Cal expansion in rural Northern California. You can read the first part here here. This project is a collaboration between EMS and Peninsula 360 Press and was funded by the California Health Equity Impact Fund 2024 from the USC Annenberg Health Center.
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