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MADELEINE BRAND, host:

This is Day to Day. I'm Madeleine Brand. In a few minutes, is Germany's neo-Nazi movement going mainstream? First, though, weekly jobless numbers out today show a slight decline in the number of people filing for benefits. At the same time, though, the number of people needing benefits for more than one week has gone up, and the total number of those seeking help is nearly twice the number it was a year ago. Well, that puts more strain on public-health programs such as Medicaid, the government-run health-insurance program for the poor. In California, the need is particularly dire because California has a $42 billion deficit. Now, though, with the expected passage of the stimulus package, California will get some help with its Medicaid payments. Capitol Public Radio's Kelley Weiss reports.

KELLEY WEISS: Atil Currin(ph) of Sacramento says he never imagined he'd qualify for Medicaid.

Mr. ATIL CURRIN: I just didn't think that I would never get to where I am today.

WEISS: Currin says he was a call-center systems engineer until he was laid off last fall. He says he extended his employer's health insurance for three months after he lost his job, but it ran out at the beginning of this year. He hasn't found another job with benefits, so he applied for Medicaid. In California, it's called Medi-Cal.

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Unidentified Woman: I'm sorry. What did you just say?

WEISS: Currin sits in a cramped and hot clinic waiting room with worn-down furniture. He needs a referral to see a skin specialist. He says it's not like when he had private health insurance.

Mr. CURRIN: Your appointment, you go in; you're seen; you're out the door. Today, I've waited for almost two hours just to be seen, and it is a runaround. It's frustrating because you're so used to going in your appointment and getting seen and leaving.

WEISS: The medical director of the Sacramento Community Clinic for the Underserved is Dr. Richard Ikeda. He says about three-quarters of his patients are on Medi-Cal, but Ikeda says recently, he's seen a change in his patient base.

Dr. RICHARD IKEDA (Medical Director, Sacramento Community Clinic): The huge number of people now that have been laid off, who had jobs before and their own private insurance, now really comprises probably over 50 percent of the business that's coming in, and these people have been forced to get onto Medicaid.

WEISS: And with that kind of increase, Ikeda says his clinic has had to respond.

Dr. IKEDA: Well, suddenly, there's much more pressure on us to be open a lot longer, and we can already see that, so we're beginning to expand the hours of our services.

WEISS: In this slumping economy, longer wait times for patients and increased stress on providers is a common theme around the country.

Ms. DIANE ROLAND (Executive Vice President, Kaiser Family Foundation): In a recession, states are where the rubber meets the road.

WEISS: That's executive vice president of the nonprofit Kaiser Family Foundation, Diane Roland.

Ms. ROLAND: Basically, when the economy turns down, as it is now, states face a real crunch: increased demand for coverage under Medicaid for those who are out of work and without healthcare coverage and decreased revenues to pay their share of the cost.

WEISS: The National Conference of State Legislatures says 43 states face budget shortfalls. And on top of that, thousands of people are losing their jobs. Last month, the country hit its highest unemployment rate in almost two decades, 7.6 percent. Roland says that means Medicaid roles go up.

Ms. ROLAND: For every percentage-point increase in unemployment, about a million more people would qualify for Medicaid or the State Children's Health Insurance Program, nationally, and about 1.1 million more would become uninsured.

WEISS: More demand, less cash, that leaves states looking to the federal government for help, especially to the federal stimulus package. The package will give states an $87 billion boost for Medicaid services. Norman Williams is the deputy director for California's Department of Healthcare Services. It's in charge of Medi-Cal. Williams says the state will take any help it can get.

Mr. NORMAN WILLIAMS (Deputy Director, California Department of Healthcare Services): Well, certainly, any financial assistance from the federal government would definitely be welcome here in California. It's a very difficult situation.

WEISS: But there are strings attached. States will be only eligible for those federal dollars if they don't cut back current Medicaid benefits to help balance their budgets. That's something many states, including California, are considering. For NPR News, I'm Kelley Weiss in Sacramento.

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BRAND: Stay with us. NPR's Day to Day continues.

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