{"id":24077,"date":"2024-06-25T14:02:33","date_gmt":"2024-06-25T21:02:33","guid":{"rendered":"https:\/\/peninsula360press.com\/?p=24077"},"modified":"2024-07-06T13:16:55","modified_gmt":"2024-07-06T20:16:55","slug":"tulelake","status":"publish","type":"post","link":"https:\/\/peninsula360press.com\/en\/tulelake\/","title":{"rendered":"Bridging the Rural Divide in Medi-Cal Services"},"content":{"rendered":"

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.<\/em><\/p>\n

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Above: Four years after its founding in 1941, the area surrounding the town of Tulelake became the site of a vast internment camp for 18,000 Japanese Americans during World War II. Today, Tulelake is a majority Latino community and one of the most underserved in Siskiyou County. (Credit: Manuel Oritz.)<\/figcaption><\/figure>\n

Listen to this note:<\/p>\n

 <\/p>\n

TULELAKE, Ca. \u2013 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.<\/p>\n

Angelina Cook, the third candidate, made access to public health care her main issue.<\/p>\n

\u201cMy motivation for running was to address the litany of unmet needs in the county, and public health is ground zero,\u201d said Cook, managing director of the McCloud Watershed Council in the town of McCloud at the southern end of Siskiyou County. \u201cWithout physical health, there is no economic health,\u201d Cook said. He lost by a wide margin.<\/p>\n

Once the \u201cwood basket\u201d of California, Siskiyou today ranks among\u00a0the poorest counties in the state<\/a>\u00a0and is consistently at or near the bottom in health outcomes, according to\u00a02023 report<\/a>\u00a0from the California Rural Policy Center at Cal Poly Humboldt.<\/p>\n

Cook calls District 1 \u2014 which encompasses much of the eastern half of the county \u2014 \u201cthe most underserved and unrepresented of all the disadvantaged communities\u201d in Siskiyou and blames county elected officials for \u201cfocusing on recruiting big industry, rather than addressing local needs.\u201d<\/p>\n

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Laura Perez runs the Early Head Start program in Tulelake, where she has lived for more than 30 years. \u201cWe don\u2019t have any support for families here,\u201d she says of the area\u2019s lack of health care infrastructure. (Credit: Peter Schurmann)<\/figcaption><\/figure>\n

For residents of Tulelake, a small, majority-Latino farmworker community on the eastern edge of District 1, that disconnect has dire consequences.<\/p>\n

\u201cWe only have one clinic, and they schedule appointments months in advance. We don\u2019t have a pharmacy. We don\u2019t have transportation. There are no providers,\u201d 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.<\/p>\n

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.<\/p>\n

A grassroots effort to meet health care needs<\/h2>\n

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.<\/p>\n

The timing couldn't be more important.<\/p>\n

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\u00a0Spectacular expansion of services<\/a>\u00a0covered by Medi-Cal to address social factors that influence health. Issues such as poverty, nutrition and housing \u2013 once considered outside the scope of traditional health care but very important to residents here \u2013 are now considered legitimate targets for Medi-Cal services.<\/p>\n

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\u00a0TEACH<\/a>\u00a0\u2012Training, Employment, and Community Help\u2012 (Training, Employment, and Community Help) Inc.<\/p>\n

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Just south of the Oregon border, Tulelake is both stunning for its natural beauty and surprising for its isolation. (Credit: Peter Schurmann)<\/figcaption><\/figure>\n

\u201cI help clients with all sorts of applications,\u201d says TEACH Family Support Worker Leticia Reyes. \u201cMedi-Cal, Cal Fresh, Cal Works, low-income energy assistance, and pretty much anything they need. We\u2019re the only place in town that does this.\u201d<\/p>\n

Reyes' colleague and fellow Tulelake native Kelly Harris says the agency \u2014 with a staff of just three \u2014 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.<\/p>\n

Asked why the county doesn\u2019t have more of a presence in the community, Reyes shrugged. \u201cI\u2019m not sure. They\u2019ve never even come out to give us training.\u201d<\/p>\n

Multiple attempts to contact county officials for this story went unanswered.<\/p>\n

Harris says part of the problem is that most of the county's attention \u2014 and funding \u2014 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.<\/p>\n

Lost in translation<\/h2>\n

Then there is the linguistic divide. Many of Tulelake's residents are monolingual Spanish speakers and need language assistance when applying for benefits. (The\u00a0Medi-Cal website<\/a>\u00a0(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.<\/p>\n

\u201cMaria is my client. When she came here two and a half years ago, she applied for Medi-Cal. Her husband wasn\u2019t working. She wasn\u2019t working.\u201d Two weeks went by and a call came from the interpreter. \u201cWhy aren\u2019t you working? Why do you always have to depend on the government?\u201d she asked Maria.<\/p>\n

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.<\/p>\n

Reyes says she made multiple calls to the county to complain. \u201cNothing ever happened. I called the front desk and they said they would pass it on to the supervisor. No supervisor ever called. Never.\u201d<\/p>\n

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.<\/p>\n

\u201cAnd 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.\u201d<\/p>\n

That was in February. The county has not yet responded.<\/p>\n

The \u2018community is showing up\u2019<\/h2>\n

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 \u2014 the latter a key challenge for many.<\/p>\n

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-m\u00e2ch\u00e9 doulas, won first prize.<\/p>\n

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Residents participate in a traditional textile workshop at a community event organized by the nonprofit SOAR Siskiyou, focusing on maternal and mental health and community and family relationships. (Photo: Peter Schurmann)<\/figcaption><\/figure>\n

\u201cEvery year more families arrive from Mexico,\u201d says Ruiz, \u201cmany of them undocumented or seeking asylum. And they don\u2019t know that these services exist, or they are afraid to ask. In most cases, they meet the requirements.\u201d<\/p>\n

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.<\/p>\n

\u201cThere are not many options other than helping each other,\u201d he says.<\/p>\n

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\u00a0trained doula<\/a>, helped launch\u00a0SOAR Siskiyou<\/a>\u00a0in 2021 (the name stands for Seeds of Ancestral Renewal) to support the health needs of low-income communities of color in the county.<\/p>\n

\u201cWhat\u2019s so unique about Siskiyou as a whole and what we\u2019re seeing here is that despite the lack of resources, despite the mistrust, the community is speaking out,\u201d he explains.<\/p>\n

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\u2019s team recently paired up with promotoras, community health workers and local artists for a community health workshop \u2013 the last of four organised by SOAR in Tulelake \u2013 focusing on maternal and mental health, and community and family relationships.<\/p>\n

'Relationships and trust'<\/h2>\n

Cook applauds these efforts, but worries they won\u2019t be enough to bring needed resources.<\/p>\n

\u201cThings get so desperate that volunteers eventually show up,\u201d he says, calling Tulelake a \u201cmodel for underserved communities in Siskiyou.\u201d But, he says, \u201cthat\u2019s not going to bring people who have the resources to do what\u2019s needed.\u201d He adds, \u201cAnd those who have the resources are in air-conditioned offices in Yreka.\u201d<\/p>\n

Still, there are signs of change, albeit gradual.<\/p>\n

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Renee Camilla (R) is a trained herbalist and doula. She helped launch SOAR Siskiyou in 2021 to support the health needs of low-income communities of color in Siskiyou County. (Credit: Manuel Ortiz)<\/figcaption><\/figure>\n

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.<\/p>\n

\u201cWe were familiar with the access challenges in rural California. Challenges that are even more difficult with this expansion to adults,\u201d said Amy Turnipseed, director of strategy and government affairs for Partnership Health.<\/p>\n

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.<\/p>\n

\u201cWorkforce and access are issues that affect all Medi-Cal providers, but particularly in rural communities,\u201d she explains. \u201cWe recognize this and try to support it by incentivizing providers to build foundations and roots\u201d in the communities they serve.<\/p>\n

\u201cThe way to reach this population is through relationships and trust,\u201d Turnipseed says. \u201cIt\u2019s building relationships, going into the community with people who can speak their language.\u201d<\/p>\n

This is the third in a series looking at Medi-Cal expansion in rural Northern California. You can read the first part here\u00a0here<\/a>, and the second part\u00a0here<\/a>. This project is a collaboration between EMS and Peninsula 360 and was funded by the\u00a0California Health Equity Impact Fund 2024<\/a>\u00a0\u2019s 2024 California Health Equity Impact Fund.<\/em><\/p>\n

You may be interested in:<\/strong> Medi-Cal adds maternal health care as one of its basic services<\/a><\/em><\/p>","protected":false},"excerpt":{"rendered":"

Tulelake, en el norte del condado de Siskiyou, se encuentra entre las comunidades m\u00e1s desatendidas en un condado clasificado entre los m\u00e1s pobres del estado. El acceso a la salud p\u00fablica es una de las principales preocupaciones para muchos. Escucha esta nota:   TULELAKE, Ca. \u2013 En marzo de este a\u00f1o, votantes del distrito 1 […]<\/p>","protected":false},"author":18,"featured_media":24078,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9,14,311,12],"tags":[],"class_list":{"0":"post-24077","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-community","8":"category-cover","9":"category-norcal","10":"category-health"},"_links":{"self":[{"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/posts\/24077","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/users\/18"}],"replies":[{"embeddable":true,"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/comments?post=24077"}],"version-history":[{"count":5,"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/posts\/24077\/revisions"}],"predecessor-version":[{"id":24178,"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/posts\/24077\/revisions\/24178"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/media\/24078"}],"wp:attachment":[{"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/media?parent=24077"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/categories?post=24077"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/peninsula360press.com\/en\/wp-json\/wp\/v2\/tags?post=24077"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}