Tulelake, in northern Siskiyou County, is among the most underserved communities in a county ranked among the poorest in the state. Access to public health care is a top concern for many.
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TULELAKE, Ca. – In March of this year, voters in Siskiyou County District 1 headed to the polls to elect their representative to the county Board of Supervisors. Among the three candidates, two listed law enforcement and support for farmers as their top priorities.
Angelina Cook, the third candidate, made access to public health care her main issue.
“My motivation for running was to address the litany of unmet needs in the county, and public health is ground zero,” said Cook, managing director of the McCloud Watershed Council in the town of McCloud at the southern end of Siskiyou County. “Without physical health, there is no economic health,” Cook said. He lost by a wide margin.
Once the “wood basket” of California, Siskiyou today ranks among the poorest counties in the state and is consistently at or near the bottom in health outcomes, according to 2023 report from the California Rural Policy Center at Cal Poly Humboldt.
Cook calls District 1 — which encompasses much of the eastern half of the county — “the most underserved and unrepresented of all the disadvantaged communities” in Siskiyou and blames county elected officials for “focusing on recruiting big industry, rather than addressing local needs.”
For residents of Tulelake, a small, majority-Latino farmworker community on the eastern edge of District 1, that disconnect has dire consequences.
“We only have one clinic, and they schedule appointments months in advance. We don’t have a pharmacy. We don’t have transportation. There are no providers,” says Laura Perez, who runs the Early Head Start program in Tulelake (population 889). Those needing immediate care must travel 30 miles across the state line to Klamath Falls, Oregon, where doctors may or may not accept Medi-Cal depending on who is on call on a given day.
Perez talks of waiting up to a year for new Medi-Cal applications to be processed by the county (according to the Department of Health Care Services, the process should take no more than 45 days) with patients paying out of pocket in the meantime. For those who do get coverage, available services are limited and often far away.
A grassroots effort to meet health care needs
But in Tulelake, a grassroots movement is slowly gaining momentum to promote health education, help residents navigate available resources and overcome the mistrust that prevents many from seeking medical care.
The timing couldn't be more important.
On January 1, California made Medi-Cal (the state's version of Medicaid) available to all eligible residents, regardless of immigration status. At the same time, the state is also conducting a Spectacular expansion of services covered by Medi-Cal to address social factors that influence health. Issues such as poverty, nutrition and housing – once considered outside the scope of traditional health care but very important to residents here – are now considered legitimate targets for Medi-Cal services.
The challenge for Tulelake activists is learning to take advantage of the resources Medi-Cal wants to put in place. At the forefront of that effort is the nonprofit organization TEACH ‒Training, Employment, and Community Help‒ (Training, Employment, and Community Help) Inc.
“I help clients with all sorts of applications,” says TEACH Family Support Worker Leticia Reyes. “Medi-Cal, Cal Fresh, Cal Works, low-income energy assistance, and pretty much anything they need. We’re the only place in town that does this.”
Reyes' colleague and fellow Tulelake native Kelly Harris says the agency — with a staff of just three — has logged about 1,600 hours since June of last year helping residents apply for Medi-Cal, all without funding. Otherwise, residents would have to make the two-hour drive to the county seat in Yreka.
Asked why the county doesn’t have more of a presence in the community, Reyes shrugged. “I’m not sure. They’ve never even come out to give us training.”
Multiple attempts to contact county officials for this story went unanswered.
Harris says part of the problem is that most of the county's attention — and funding — is focused on towns and communities that parallel the I5 corridor that runs north to south through central Siskiyou. Places like Tulelake, far to the east and just a stone's throw from the border with neighboring Modoc County, tend to be left out in the cold.
Lost in translation
Then there is the linguistic divide. Many of Tulelake's residents are monolingual Spanish speakers and need language assistance when applying for benefits. (The Medi-Cal website (The county's interpreter is only available in English, with a phone number that those needing help in Spanish can call.) Reyes recounts a disturbing encounter one of her clients had with a county-hired interpreter.
“Maria is my client. When she came here two and a half years ago, she applied for Medi-Cal. Her husband wasn’t working. She wasn’t working.” Two weeks went by and a call came from the interpreter. “Why aren’t you working? Why do you always have to depend on the government?” she asked Maria.
According to Reyes, this was not an isolated case. Other residents who wanted to enroll in Medi-Cal had had similar encounters with this same interpreter.
Reyes says she made multiple calls to the county to complain. “Nothing ever happened. I called the front desk and they said they would pass it on to the supervisor. No supervisor ever called. Never.”
Eventually, Maria was able to get herself and her husband enrolled. But as Reyes explains, the couple later lost coverage once her husband started working in the fields and their earnings put them over the eligibility limit. The problem is that farm work in Tulelake is seasonal. And once the season ended, Maria and her husband tried to re-enroll.
“And once again the interpreter called. 'Why are you still doing this? You need to find another job. Stop depending on the government? It's not right.' And once again I complained.”
That was in February. The county has not yet responded.
The ‘community is showing up’
Perla Ruiz, who moved to Tulelake from Mexico in 2014, works as a health and education specialist in Modoc County, where she helps manage a program that connects families with health services, including things like nutrition and transportation — the latter a key challenge for many.
In her spare time, she leads local dance classes for residents and last year helped design a float for the local Day of the Dead parade. The float, which featured papier-mâché doulas, won first prize.
“Every year more families arrive from Mexico,” says Ruiz, “many of them undocumented or seeking asylum. And they don’t know that these services exist, or they are afraid to ask. In most cases, they meet the requirements.”
In the absence of support from Siskiyou County, Ruiz says residents are looking out for each other. She points to an older woman who works at a nearby store selling goods from Mexico and who, in her spare time, offers to give people rides to appointments or helps sort through any piece of county or state mail.
“There are not many options other than helping each other,” he says.
Renee Camilla agrees. Camilla was born and raised in San Francisco. The daughter of immigrants from Nicaragua, she moved to Siskiyou nine years earlier. Herbalism and trained doula, helped launch SOAR Siskiyou in 2021 (the name stands for Seeds of Ancestral Renewal) to support the health needs of low-income communities of color in the county.
“What’s so unique about Siskiyou as a whole and what we’re seeing here is that despite the lack of resources, despite the mistrust, the community is speaking out,” he explains.
SOAR uses art, culture and traditional practices to bridge the gap with immigrant communities who might otherwise feel alienated by social services like public health. Camilla’s team recently paired up with promotoras, community health workers and local artists for a community health workshop – the last of four organised by SOAR in Tulelake – focusing on maternal and mental health, and community and family relationships.
'Relationships and trust'
Cook applauds these efforts, but worries they won’t be enough to bring needed resources.
“Things get so desperate that volunteers eventually show up,” he says, calling Tulelake a “model for underserved communities in Siskiyou.” But, he says, “that’s not going to bring people who have the resources to do what’s needed.” He adds, “And those who have the resources are in air-conditioned offices in Yreka.”
Still, there are signs of change, albeit gradual.
At the entrance to the SOAR event, Partnership Health, the managed care network that covers Siskiyou and about 24 other counties in far northern California, set up an information table with a Spanish-speaking representative who had just presented a workshop four hours west in Del Norte County.
“We were familiar with the access challenges in rural California. Challenges that are even more difficult with this expansion to adults,” said Amy Turnipseed, director of strategy and government affairs for Partnership Health.
According to Turnipseed, the Partnership has enrolled 70 new patients in Tulelake since the expansion phase of adult Medi-Cal began on Jan. 1. It is also working to bring on more providers through an ongoing recruitment program and expand the number of community health workers in the area.
“Workforce and access are issues that affect all Medi-Cal providers, but particularly in rural communities,” she explains. “We recognize this and try to support it by incentivizing providers to build foundations and roots” in the communities they serve.
“The way to reach this population is through relationships and trust,” Turnipseed says. “It’s building relationships, going into the community with people who can speak their language.”
This is the third in a series looking at Medi-Cal expansion in rural Northern California. You can read the first part here here, and the second part here. This project is a collaboration between EMS and Peninsula 360 and was funded by the California Health Equity Impact Fund 2024 ’s 2024 California Health Equity Impact Fund.
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