Leana Powell is one of the 7.6 million Californians who rely on Medicaid, also called Medical, for health care. The 27-year-old, full-time student and mother has dreams of becoming a nurse. If there are more cuts to the system, she fears the worst.
"Everybody who uses social services, Medical, they're not criminals," said Powell.
But the cuts are coming, the $90 billion Washington pumped into Medicaid two years ago as the recession worsened runs out this week.
Luan Huynh advises the poorest of the poor at the East Bay Community Law Center she says people are already being forced to make desperate decisions.
"You decide one verses the other and if you decide medical copay so that your kid can see the doctor, well you may not have money to pay rent," said Huynh.
Part of these cuts mean that states like California will be forced to reduce Medicaid payments to doctors and hospitals and that means poor people will have an even tougher time getting medical treatment.
The cuts also mean that California recipients pay new copays for drugs, doctor appointments and hospital visits. And they'll get just seven doctor visits a year, unless a doctor approves more.
John Graham directs health care studies at the Pacific Research Institute think tank.
"There's a reality here that we've hit, that we're bust. And despite massive increases in Medical spending over the years, we're not seeing good outcomes, we're not seeing good access to care, so we need a fundamentally different model," said Graham.
Washington is considering even more cuts and Powell can't imagine what that might mean for her or her future.
"I have worked. I'm not someone who's abusing the system. I'm doing something so that I can become a productive citizen," said Powell as she teared up and cried.