Fear, illiteracy, the stress of poverty.

For years, politicians and policymakers have talked about the need to expand health coverage to those who are uninsured.

But for years, there have been programs in place for low-income Kansans that provide free or low-cost health care, and yet thousands of people who are eligible for those programs don’t sign up for them.

Last week, legislators asked workers on the front line of delivering health care to the poor, why?

Krista Postai, chief executive officer of the Community Health Center of Southeast Kansas, a clinic in Pittsburg, said it takes a lot of effort. “One person, one child at a time … that’s how it’s done.”

State health leaders say there are an estimated 40,000 Kansas children who are uninsured and potentially eligible for Medicaid or HealthWave, the state’s health plans for low-income people.

“That’s too high,” said Andrew Allison, deputy director and acting Medicaid director. “We feel we can do better than that.”

Getting those children in a health plan with routine medical care will save money by reducing emergency room care, health officials said.

But Postai said enrolling applicants is often difficult.

She said the paperwork necessary to get HealthWave or Medicaid is often confusing. The rules change. Sometimes the adults in the family are illiterate.

Because poor families frequently move, they may not receive their renewal forms.

And, she said, new federal rules requiring proof of U.S. citizenship, such as a birth certificate, have created obstacles.

At her clinic, she said, a recent retiree from the Kansas Department of Social and Rehabilitation Services has volunteered and handles each application on a personal basis.

“Basically, she just chases them,” Postai said, adding that giving a person a slick brochure about a program won’t accomplish the task.

In two months, this volunteer went through 131 patients and so far has gotten 46 covered by HealthWave or Medicaid, Postai said.

Postai said she intends to use “every trick I learned from timeshare salesmen in Branson” to get children enrolled for health care.

Pat Cameron, with Inter-Faith Ministries of Wichita, said there are other programs that many low-income people are eligible for and don’t take advantage of.

Cameron said only 57 percent of eligible Kansans apply for and receive food stamps, and about 15 percent eligible for the Earned Income Tax Credit do not apply for it.

Cameron’s group will launch the Kansas Benefit Bank later this year that will help people apply for benefits, including health care.

Marcia Nielsen, executive director of the Kansas Health Policy Authority, said the agency has requested about $1.2 million for outreach programs. She lauded local programs that have provided personal assistance with the enrollment process.

Meanwhile, Postai said she lives in fear that children who could receive free or low-cost health care don’t because their parents don’t know it’s available.

“I never want to wake up and read a child died in Pittsburg, Kansas, because his family couldn’t afford health care,” she said.