Marta Chavolla is still paying off a $590 emergency room bill for one of her five children. Without insurance, the ER was a costly last resort when her son's arm hurt in December.

The 33-year-old Turlock mother, who works at a linen service factory, knew she needed health care coverage for her family. She applied three times over six months without success.

Between getting time off work, finding transportation to the Turlock office of the Stanislaus County Community Services Agency and the confusing paperwork, she never got through the process.

Then a school nurse told Chavolla that there was someone who could help.

Two weeks ago, Chavolla signed up her children for state insurance in 30 minutes, in a school five blocks from her house, and in Spanish, the only language she speaks.

Isabel Perez guided Chavolla through the process. Perez is a bilingual outreach worker who had contacted Turlock schools a few weeks before to remind them about the state's Healthy Families and Medi-Cal insurance programs.

If Chavolla is approved for Healthy Families, she will pay $27 per month for full coverage for her children.

For three months, Perez and other outreach workers combed Modesto's flea markets, visited isolated farms near Grayson, dropped by church meetings in Ceres and walked through migrant worker camps in Riverbank.

Grass-roots efforts like that are credited with getting thousands of minorities and poor people out of emergency rooms and into the health care system over the past decade.

But all eight of Stanislaus County's Healthy Families and Medi-Cal outreach workers expect to be out of work Monday, the first victims in a wave of health care cuts being proposed to make up for the state's nearly $23.6 billion budget deficit for the 2002-03 fiscal year.

"People were just finding out we are here," Perez said. "Now that trust will be broken."

Health care advocates say cuts to outreach funding will mean fewer people signing up for insurance, more overcrowding in emergency rooms and a long-term increase in health costs for the state.

But in an election year with a budget deficit, short-term concerns take precedence.

As of Friday afternoon, a legislative committee had agreed to Gov. Davis' revised budget of $10.3 million for Healthy Families and Medi-Cal outreach, a reduction of $39.3 million from last year. While outreach workers have been cut from the budget entirely, funding for some other types of enrollment assistance is expected to be unaffected.

The final figures will not be known until the Legislature and Davis sign off on the budget in coming weeks.

Proponents of cutting outreach argue that, while important, it is an expendable program given the size of the state deficit.

Others say outreach is essential, considering that 1.1 million of California's 1.6 million uninsured children are eligible for but not enrolled in health care.

"It's like deciding what limb to cut off," said Anthony Wright, a spokesman for the health care consumer coalition Health Access. "If a family is not enrolled, it has no way to access the services."

234 families in eight weeks

In April, Perez and the other bilingual workers -- all women -- began reaching out to the more than 28,000 uninsured children in Stanislaus County.

As community members themselves, the outreach workers explained the health system to their audience more effectively than past outreach efforts, which used a combination of advertising and toll-free telephone lines.

Lilia Villa of Oakdale used to wait 30 minutes on hold when she called to ask a quick question about her Healthy Families application. She said she waited so often and for so long that she memorized the lyrics to the hold music.

Then Patty Torres, an outreach worker based in Oakdale, helped Villa in minutes.

"Without Patty, I would still be waiting on the help line," Villa said in Spanish.

Over the past eight weeks, the outreach workers enrolled 234 families, on pace to exceed their two-year goal of 2,400 families, said Bernadette Paul of the Community Building Project, a coalition of community groups in charge of the outreach program.

Now, after just three months of work, the state has canceled the project's two-year contract and ordered the return of all but $80,000 of the $440,000 contract amount to Sacramento.

A barrier to health care

Cleopathia Moore, associate director of the Stanislaus County Health Services Agency, said cuts could reverse much of the progress made in bringing health care to outlying communities.

Moore was one of the founding members of the Stanislaus Multicultural Community Health Coalition, a group of health professionals that formed in 1991 to make health care more accessible to minorities and the poor.

"Budget cuts come every year," Moore said, but this year's cuts are different. "They are so broad. They are not just impacting public health, but the entire health system."

The county, which employs more than 20 of its own health outreach workers, is expecting significant cuts, Moore said.

Chay Khun, a health outreach worker for the county, said outreach is particularly important in an environment of budget cuts.

"In the reality of this society, no program is going to last long," Khun said. "Some people don't know about a program until it is closed. When an outreach worker is there, they know."

Khun, who speaks English and Khmer, said that of the 5,000 Cambodian families in the county, about 20 percent speak limited English. But even those who speak English frequently come to him for help, Khun said.

Even privately funded community groups have something to fear from state budget cuts.

Cuts can trickle down

"Budget cuts will trickle down to us," said Carol Collins of the West Modesto-King Kennedy Neighborhood Collaborative, a privately funded community resource center. The collaborative partners with state-funded outreach workers to spread the news about west Modesto's new clinic, which opened May 19 after years of struggle.

"If we don't have enough people to get the information out to the community, they won't know about the new clinic," Collins said.

"If the state is cutting outreach, that means someone else is going to have to pick it up. We're gonna need dollars to do that."

Julie Williamson, associate director of the Partnership for Public Health, which supports the collaborative with funds from the California Endowment, warned that money is unlikely to come from private foundations.

"Foundations are more of a catalyst. They're not in the business of providing the stable infrastructure that governments can provide," Williamson said.

And when the government cannot provide that stability either?

"People are going to start feeling it," Williamson said.

Bee staff writer Jason Felch can be reached at 578-2330 or jfelch@modbee.com.

Reprinted by permission of Modesto Bee.