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 and pleasant voice. At 45 years old, 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 a rural area, residents say, it is a remote rural area, California's last frontier, and it is here that the state's plan to expand access to health care to all residents is being tested.
?I do not have a house. Other people help me here. It helps me find work; They give me food and I sleep in my car. Isn't it as bad as those who sleep outdoors? explains Urrea, (who is nicknamed Caballo), while pointing to an abandoned BMW.
Packed with blankets and personal belongings, the car is parked in the middle of a row of trailers that house about 50 farm workers and their families. The vast majority are from Veracruz, Jalisco or, in the case of Urrea, Guanajuato. At the entrance to the park there is a yellow sign that reads: ?Welcome to Smith River. World capital of the Easter lily?
In years past, immigrants – many of them undocumented – They came and went 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 resort to day jobs to survive.
"It's expensive here," Urrea continues in Spanish. ?When people don't have jobs, they can't pay their rent. I've been sleeping in this car for three years.
Manuel Ortiz reports on the lack of Medi-Cal eligibility information available to farmworkers in Smith River, Del Norte County, for the radio show Por la Libre. (Only in Spanish. Do Click here to read a transcript in English).
Starting Jan. 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.
However, news of the expansion has not yet reached farmworkers here, many of whom are uninsured and would potentially qualify.
Don't get sick here?
?I got quite sick a few years ago. "They didn't cover my medications?" Urrea says, referring to the clinic he 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, in his 30s, has lived here in one of the trailers for two years. ?I got sick three months ago and I only took some pills.? And he adds: “We are Latinos, immigrants… It is not easy for us to get insurance.”
Smith River is located in the northwest corner of Del Norte County, a sparsely populated corner of Northern California between Humboldt County to the south, the Oregon border to the north, extensive 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), although 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 the 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 haven't had access to medical care since they've been here,” he says, “and so some of their health conditions are frightening 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 Department of Health Services. California Health Care (DHCS) to help inform local communities about Medi-Cal eligibility. The initiative will be valid until mid-2026.
Doing that in places like Del Norte, where distances are long and resources few, is not without challenges.
"There's no easy channel of communication up here," says 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 noted. ?It's been like this since I've lived here 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 supervises his work. “Their success has relied heavily 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 were not enthusiastic 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 the lunch breaks are short (half an hour) and then they return to work?
Open Door also scanned patient records from 2022 and 2023 to see who had previously accessed care but was uninsured. These people were enrolled in emergency Medi-Cal and are now eligible for full-scope Medi-Cal under the current expansion, although 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 is also a lack of suppliers. ?It's really difficult to find providers who want to live and work in Crescent City. Sometimes we find a great supplier and they stay. Most of the time, they leave? Moreno says, noting that there is only one ophthalmologist in Crescent City who sees Medi-Cal patients, and his waiting list is at capacity.
The policy increases distrust, as undocumented residents have to weigh their health care needs with fear of stirring anti-immigrant sentiment and jeopardizing their path to citizenship or legal residency by accessing public benefits, which under the administration above could be grounds for deportation.
"That's something real that worries people," says Moreno. "We heard one person say, 'If my information gets out and I'm deported, at least I'll have access to medical care.'"
"You have to take care of yourself"
Back in Smith River, trailer park residents were sometimes unaware and unsure about the current expansion of Medi-Cal.
"I had never heard of Medi-Cal," says Alberto Hernández, originally from Chiapas and resident here for the past 11 months. When asked what he does when he gets sick, he shrugs. ?Don't know? here it is very expensive. Maybe return to Mexico?
Anancio Hernández works as a local chef. ?A month or two ago I had some pain. But I continued working, even though I was sick?, he says. “I don't have insurance, so I didn't go to the hospital.” When asked if he would enroll in Medi-Cal if given the chance, he nodded. “I will go investigate it to see if there is this opportunity.”
For her part, Urrea shares that her mother, who also lives in Del Norte, was recently hospitalized after suffering a stroke. She lost sight in her left eye, she says. Like him, she has no 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. Is that the bad thing here?
Additional information from Manuel Ortiz.
This is the second in a series looking at the expansion of Medi-Cal in rural Northern California. You can read the first part 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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