Forty-nine counties are now getting federal money to give health services to the poorest of the poor.
But getting on board with the Low Income Health Program has been easier for some counties than others.
Dr. Sandy Damiano of Sacramento County Health and Human Services says the county is still in the planning phase.
DAMIANO: "It is a huge, huge, undertaking with very intricate processes. Even using a health plan has taken us a long time because of all of the other work that must be done."
Damiano says the work amounts to building a whole new health infrastructure.
Other counties signed on to the early Medicaid expansion last summer and include people which higher incomes.
Statewide, more than 400,000 people are covered through the new county health programs.