During the lean years that beset California's budget for most of the last 14 years, one preferred way that elected officials chose to cut spending was to overwhelm the poor with paperwork.
They discovered they could trim hundreds of millions from state spending without actually having to overtly appear heartless. Rather than, for instance, take away government-paid health insurance for a single mother with an income of $15,000, they would require her to fill out more demanding forms and to do it more frequently.
That way, if she lost coverage for her family it wasn't the government's fault. Rather, it was hers for failing to maneuver her way through red tape. It was an effective way of curtailing the costs of an entitlement program.
Then came the Affordable Care Act.
As you may have noticed, that triggered a certain amount of public awareness of government-administered and government-run health care programs.
In addition, millions of Americans - parents with incomes between 106 percent and 138 percent of poverty guidelines, as well as childless adults with incomes below 138 percent of poverty - became newly eligible for coverage.
In California, advertising paid for by charitable foundations and outreach by grass-roots organizations combined to do a fairly effective job of spreading the word that there were new opportunities to obtain government-paid health insurance.
Not surprisingly, those efforts reached not only those low-income families who were newly eligible for Medi-Cal, but also hundreds of thousands who were already eligible but either had never enrolled or had lost their coverage because they hadn't kept up with the paperwork.
And now California officials find themselves in a situation they hadn't quite anticipated. More than 3.6 million additional Californians are now enrolled in Medi-Cal than had been just two years ago, a figure somewhat inflated by the fact that the previous Healthy Families program that provided coverage for kids was rolled into Medi-Cal.
For all those who enrolled who were newly eligible, the federal government under the Affordable Care Act is picking up 100 percent of the costs. But for those who were already eligible but not enrolled, the costs are split 50-50 between the state and federal governments.
The result, Gov. Jerry Brown said Tuesday as he released his revised state budget, is that Medi-Cal costs have gone up $2.4 billion over two years. One reason for the magnitude of that increase, he noted, is that the federal government limited the amount of paperwork states could require recipients to complete to establish and maintain their eligibility.
Brown administration officials said Tuesday they were surprised that 800,000 previously eligible recipients enrolled in Medi-Cal last year, a number than exceeded their projections by more than 300,000.
Anthony Wright, executive director of the advocacy group Health Access, said the numbers should not be seen as a surprise, but rather "a correction."
"People had been eligible but unenrolled for years," he said. "The state had been doing a good job of discouraging them, or at least not connecting with them."
Although Brown stressed that Medi-Cal costs are now higher than anticipated, he also asserted that it's a good thing that so many who previously had not insurance are now covered.
"This is not going to the middle class, it's not going to the rich," he said. "It's going to the people who are struggling the most."
It was clear at the Capitol on Tuesday that the increasing costs of Medi-Cal caught more than just administration officials off-guard.
"It was a real eye-opener for me, for others and for the governor," said Assemblyman Jeff Gorell, the lead Republican on the Budget Committee. "The challenge we are going to have is with this unexpected growth in health care spending."
In many ways, the costs reflected in Brown's new budget simply reveal the actual costs of an entitlement established decades ago - a policy decision that those at or near poverty should not go without medical care.
With high unemployment, coupled with wages that are low and stagnant, 30 percent of Californians now qualify for Medi-Cal.
As Gorell notes, that will create increasing challenges in the future as health care costs compete with schools, universities and other programs for general fund dollars.
Decisions will have to be made about whether to continue the entitlement, where to set the point of eligibility, how much taxes will be needed to pay for it.
Those are the hard questions. The answer never really was, and never should be again, to avoid them by burying the poor in paperwork.