San Diego’s Safety Net: Riddled With Gaps

San Diego’s Safety Net: Riddled With Gaps

Sam Hodgson

Devoid of health insurance and denied coverage by the county of San Diego, Michele Quemuel lost sight in both her eyes. She believes she would still be able to see if the county hadn't denied her coverage.

PART ONE

Michele Quemuel clutches her mom’s elbow as she navigates the hallway in a 1970s-era home in Spring Valley. She frowns, testing the ground beneath her feet before taking every tentative step. Her white cane whacks a plastic chair and she jumps a bit, startled.

Quemuel is 36 years old and legally blind, her sight totally gone from both eyes. She believes she would still be able to see if San Diego County hadn’t denied her health care coverage in 2002.

Back then, Quemuel was waitressing at a Spring Valley retirement community, in a job that paid $7.32 an hour. When her work started deducting more from her paycheck for health insurance, Quemuel opted out and lost her coverage. She didn’t think she could afford it.

Her insurance had been a necessity. Quemuel always went to the doctor regularly. She needed to. She’d been a diabetic since high school.

So she applied for help from County Medical Services, a program that pays for essential care for poor, uninsured patients. A county worker told her that she made too much money to qualify. The county’s cap was $802 a month. Quemuel earned $935. Her parents, retired and on fixed incomes, couldn’t help.

Two years passed. Quemuel didn’t go to a doctor. She didn’t get insulin. She started having vision problems. What she could see seemed dimmer. Even then, she couldn’t afford medical treatment. She says she didn’t know how bad it could get. She felt like she didn’t have any other choice.

On July 1, 2004, a doctor declared her legally blind.

The next year, the limits that had kept Quemuel out of the health care program were declared illegal. Courts have since forced the county government to increase its income caps twice in the last five years, boosting them to what is now nearly $1,500 a month.

But that came too late for Quemuel. Almost six years later, she lost her job and is reliant on her family to take her wherever she needs to go.

The worst part, she says, is not being able to see her mom and dad.

♦♦♦

San Diego County’s safety net is riddled with gaps like the one Quemuel fell through.

A voiceofsandiego.org investigation has found that the county government’s historical resistance to provide social welfare programs has left a wide chasm between last-resort aid and those on the bottom rungs of economic survival.

Those gaps have left the sick like Quemuel to get sicker. They have locked applicants in months of bureaucratic and legal runaround. They have kept help out of the hands of professionals who’ve fallen on hard times during the recession. It has sometimes taken a judge’s order to force the county to provide even a minimum level of help.

The state obligates counties to run aid programs including food stamps, welfare for families and medical help, and to provide care for adults who can’t support themselves. But it has made profound cuts to the funding the counties get, leaving them to find a way to keep the programs running.

While other counties have embraced the charge to provide the services, San Diego County supervisors have rebelled against picking up the slack.

The elected officials have battled the state over the fine print of what they’re obligated to provide. They’ve created such restrictive policies that courts have had to intervene. They’ve instituted some of the most far-reaching anti-fraud policies in the state.

And they make few apologies for it.

“It is a tough task, because it’s a balancing act,” said Supervisor Dianne Jacob. “But if I take police officers off the street to hand out welfare checks to those who don’t deserve it because I’ve eliminated a fraud program, am I doing my job? I’d say no.”

Poverty reached a 50-year high last year in San Diego, and the people who use these programs don’t have a single profile. Their ranks include the weathered faces of the homeless and harried single parents with many mouths to feed. They are low-income students trying to break generational cycles of poverty. They are former mortgage brokers and hotel workers. They live in households where two incomes have been lost, their livelihoods dashed by the economic recession.

“Geographically, a person who lives in San Diego who’s poor has no less need for these programs but they have more difficulty getting them,” said Katie Murphy, an attorney with the Western Center on Law and Poverty, a statewide advocacy firm that successfully sued to raise the county’s income limits on the health care program.

The gaps in the safety net have a wider cost: The San Diego region left nearly $110 million in federal funds on the table in 2007 because so few county residents receive food stamps, according to a leading anti-hunger group.

There has been a trickle of news about the county programs in recent years, as lawsuits and studies focus temporary spotlights on the county’s care for its poor. But those aren’t isolated cases.

The VOSD investigation found a wider pattern of holes across San Diego’s safety net. Across California’s 12 largest counties, San Diego ranks at or near the bottom for connecting the poor with several key aid programs, according to a study conducted by the Rose Institute of State and Local Government at Claremont McKenna College and done in coordination with the investigation.

VOSD interviewed more than 100 participants, applicants, advocates and county officials to put together a comprehensive picture of the last-resort programs for people in economic strife.

Among the findings, San Diego County has:

  • The lowest enrollments: For five years, an annual study has pegged San Diego at the bottom of 24 metro areas nationwide for enrolling eligible residents in food stamps. The county is among the bottom three of the state’s 12 biggest counties for providing CalWORKs, which is welfare for families, and Medi-Cal, which is public health insurance, to those estimated eligible for it, according to the Rose Institute.
  • The highest denial rates: San Diego County turned down the largest percentage of applicants for both food stamps and welfare for families compared to the state’s largest counties, according to the Rose Institute.
  • Dwindling funding: While the number of San Diego County cases has gone up 71 percent for food stamps and welfare for families since 2002, state and federal funding has increased by only 17 percent.

These aren’t all of the county’s social service programs. The Health and Human Services Agency’s $1.8 billion budget covers everything from adoptions and foster care to mental health services and public health.

But together, food stamps, CalWORKs, Medi-Cal and County Medical Services make up the county’s major social welfare programs, meant to provide an economic and medical safety net for a wide spectrum of needy San Diegans.

Denied

Juan Aguilar knows what his life could look like if he hadn’t gotten help: He’d be back at his old job cooking and cleaning at a taco shop on El Cajon Boulevard.

Aguilar is a 23-year-old father, husband and business student. And he’s been fighting with the county for a year to get the help for which he qualifies.

He worked full-time for nearly all of the four years it took him to finish his associate’s degree. He barely had time for his toddler daughter, Genesis. And when he transferred to San Diego State University, the work-school balance toppled.

With his friend’s urging, Aguilar applied for food stamps and cash aid through CalWORKs a year ago. The program helps low-income students with children to finish getting their degrees and permanently pull themselves out of poverty.

When Aguilar first applied, the county sent him a letter: Denied.

That was an error. A county worker saw Aguilar’s tuition money in his account, and counted him over the limit. But that money was from Aguilar’s student loans and grants, which are exempt from the calculation.

Aguilar nearly gave up. But an advocate helped him contest the denial in an April hearing. He won. The judge ruled that Aguilar was due back payments for both programs, which he received.

But even after the judge’s ruling, Aguilar still had problems. He didn’t get his cash aid for several months. One month, he didn’t receive his food stamps. By November, he was so frustrated with the county he nearly quit his unpaid internship to return to restaurant work to pay the bills.

Finally, in December, after months of fighting, he received his missing aid.

The county denies a lot of applicants.

Click to enlarge

It denied more than half of food stamps applicants in fiscal year 2008. And it denied more than 60 percent of the applicants for CalWORKs. San Diego’s denial rates are the highest of any of the 12 counties in the Rose Institute analysis.

County leaders say they just follow rules that the federal and state governments set.

“I don’t think we make any apologies,” Supervisor Greg Cox said.

But in some cases, like Aguilar’s, those denials are based on county errors.

A 2008 state audit found that out of a sample of 15 denied food stamps applications, county workers improperly rejected two — both without adequate explanation or documentation in the file.

Like Aguilar, some applicants find an advocate and request a hearing to overturn the denial.

The county says less than 1 percent of applicants who appeal their denials are successful. But it’s impossible to know how many people don’t realize that the county’s “no” doesn’t always mean “no.”

Aguilar is a savvy business student — his La Mesa home is piled with papers he’s kept to use in his appeals to the county. Now he’s anticipating his university graduation this spring, not working in the restaurant.

But after getting his back payments in December, his January CalWORKs payment didn’t arrive. He believes he’s eligible and supposed to receive aid. Aguilar requested a hearing and got the money in the meantime, but he’ll have to wait for another judge’s ruling to see if he can keep it.

Aguilar is back to fighting with the county.

Bottom of the Heap

Again and again, San Diego County ranks at or near the bottom in enrolling eligible participants in social welfare programs:

  • Last for food stamps: San Diego enrolled 35 percent of eligible residents in 2007, the lowest nationwide, according to the most recent report from the Food Research and Action Center, a nonpartisan anti-hunger group.
  • Last for Medi-Cal: San Diego County was the only one of the state’s 12 largest counties to enroll less than half of the eligible residents in Medi-Cal’s largest category in 2007, according to the Rose Institute study.
  • Third from last for CalWORKs: San Diego County enrolled about 64 percent of eligible residents in 2008 for the welfare-to-work program, ranking third from last out of the 12 counties in the Rose Institute study.

Click to enlarge

County officials reject the idea of comparing themselves to other places, saying they only track their performance over time. They said they know they can always do better and noted that food stamps participation has grown significantly in the last year. But it’s too early to tell if that’s a function of the recession or if new outreach efforts are paying off.

They hypothesize that San Diego’s demographics — impacted by immigration, the military, the county’s large college campuses and tribal areas — complicate comparing the county to others. Officials offered no numbers to quantify that impact.

Knowing how many people are eligible for the aid but not getting it is impossible, said Dale Fleming, director of strategic operations for the county’s Health and Human Services Agency.

But it is possible to estimate it. The Rose Institute study bases its estimates on an individual’s income, number of children, and, in the case of CalWORKs, unemployment. The actual number of San Diego residents who are eligible depends on factors that weren’t measurable in the study, such as underemployment, savings or car values. Those factors would be present in all 12 counties, not just San Diego.

County officials say the state makes them handle these programs, tells them how to run them and doesn’t give them enough money to do it. If the state or federal governments want the programs to extend further, it’s their responsibility to send more money, Supervisor Jacob said.

“I get out in my communities quite a bit. I have not heard from any of my communities that we need to hand out more food stamps or I need to pass out more welfare checks,” Jacob said.

♦♦♦

Michele Quemuel lost her sight and her independence.

She cut her waist-long hair up to her chin so she can care for it. She’s not working. Her boyfriend picks out her outfits in the morning. She sometimes sits and listens to the TV, unable to see the picture, or walks around the mall, asking sales clerks to describe the items on sale. She’s half-heartedly trying to learn Braille and is thinking of trying to bowl in the Special Olympics.

Quemuel’s disability means she receives state medical care now. But she relies on her parents for everything. Rides to four doctors for her various check-ups. Trips to the pharmacy for more insulin. Laundry.

Since Michele Quemuel lost her sight, she’s been reliant upon her family to take care of her. She now uses a cane to find her way around and is thinking of trying to bowl in the Special Olympics. Photo: Sam Hodgson

The last time she could see her parents, they were younger and healthier.

Her father is 77 years old and walks slowly these days, shuffling his feet around the house. Since Quemuel went blind, her 70-year-old mother was diagnosed with cancer, went through chemotherapy and had a pacemaker installed.

Life hasn’t just changed for Quemuel; it’s changed for her family. They aren’t sure how much longer they can support her like they do.

“Why did she fall through the cracks?” her sister, Marla Quemuel-White, asks.

She invokes her little sister’s family nickname.

“Why did ‘Chele fall through?”

♦♦♦

MONDAY | County Government Resents Bearing Safety Net’s Burden: The wide social-aid chasm in San Diego County results from an ingrained political culture and a battle between the county and state that’s dragged on for decades.

MORE | Check in with the Survival in San Diego blog regularly as we keep telling this story throughout the week.

Please contact Kelly Bennett directly at kelly.bennett@voiceofsandiego.org or Dagny Salas at dagny.salas@voiceofsandiego.org. Follow them on Twitter: twitter.com/kellyrbennett and twitter.com/dagnysalas.

Photography By: Sam Hodgson

Graphics By: Sarah Johnson

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Kelly Bennett

Kelly Bennett

Kelly Bennett is a freelance contributor to Voice of San Diego. You can reach her directly at kelly@vosd.org.

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Dagny Salas

Dagny Salas

Dagny Salas was the former web editor at Voice of San Diego from 2010 to 2013. She was an investigative fellow at VOSD from 2009 to 2010.

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2 comments
Hank Pfeffer
Hank Pfeffer subscriber

San Diego government has apparently forgotten something important. "There but for the grace of God go I."

Hank Pfeffer
Hank Pfeffer

San Diego government has apparently forgotten something important. "There but for the grace of God go I."