Santa Cruz County's safety net health services -- community clinics and hospitals that provide many low-income and uninsured residents with their only medical treatment option -- are starting to see the impact of the area's growing number of uninsured children.

County health clinics, already strapped for resources due to state cutbacks and lower property tax revenues, are increasingly busy with families needing medical care covered by Medi-Cal, Healthy Families or the local Healthy Kids program, which as recently as 2007 had helped the county achieve 98 percent insurance coverage for its children. But despite the recent increase in the numbers of uninsured children and the prospect for draconian cuts in state-run programs for low-income families, new enrollment in Healthy Kids was frozen in June after the down economy prompted a drop-off in financial support.

"Families are more stressed than we've seen them in ages," said Rama Khalsa, director of the county Health Services Agency, which oversees the county's two clinics, in Santa Cruz and Watsonville. "My triage nurse who sees our walk-in patients, there are people crying in her office all day long. My staff wants to help in any way they can."

Wait times can be up to six weeks for general visits, though the staff will see urgent cases more quickly. Once new uninsured families get in, the staff encourages them to apply for coverage with Medi-Cal or Healthy Families. Some programs require a low co-payment for doctor and clinic visits.

"Even though it's a modest payment, families will often delay services if there is any cost involved," Khalsa said. "We think it's a problem for families to delay care, because things could get a lot worse."

Many of the new uninsured people walking into county clinics were employed in retail or tourism businesses that have closed, Khalsa said. At particular risk, she said, are middle-class families that earn too much money or have too many assets, like a home, to qualify for public health assistance. If their employer has reduced their hours or done away with employee health care, or if they've recently lost their job, these families often are left with overwhelming financial obligations and have no money to pay child health insurance costs.

Joe Landers, who runs the county's Watsonville Health Clinic and specializes in pediatric care, said the center is "exploding with patients." While the clinic, which has about 4,000 kids on its roster, is still open to taking new kids, "We are pretty much running at maximum capacity" considering staff has been cut.

In 2007, 8.4 percent of the children seen at the nonprofit Dientes Community Dental Care clinic in Santa Cruz were uninsured. By 2009, officials say, the rate had jumped to 15.3 percent. At the high-poverty schools where the clinic started doing outreach last spring, some 35 percent of the children they treat have no dental insurance.

This past fall, officials at the Santa Cruz Women's Health Center saw a substantial increase in the number of uninsured kids from the same period the previous year -- from about 2.7 percent of all children, to about 4.7 percent.

Dr. Maria Mead, the center's medical director, said that until recently she rarely saw any uninsured children.

"It was so nice because you didn't have to worry about the kids not being insured," she said. "You knew antibiotics and visits were covered."

Healthy Kids was designed to provide insurance for kids like those Mead sees.

"Now we have kids who are cash-pay, and families have to think about whether they can pay for medicine," Mead said.

Officials at county hospitals are worried about the fallout of fewer children having access to Healthy Kids if its program stays frozen, as well as the effect that persistent unemployment and the rising cost of insurance will have on preventative care.

Dr. Nanette Mickiewicz, Dominican Hospital's president, said even though the volume of ER visits by insured and uninsured patients has been statistically flat for the past several years and there is no waiting list for the hospital's pediatric clinic, she feels a "looming crisis" as the jobless rate climbs and many people who have lost jobs may lose their COBRA insurance in the coming months.

"What is fascinating to me is that we have not seen the upswing that one would have expected," Mickiewicz said. "I think it's a testament to safety net clinics. They really have stepped up and made sure they have preventative health care."

She said the idea of every uninsured child having a "medical home" with a primary care physician is in jeopardy, and Mickiewicz fears that well-child visits and well-adolescent visits are dropping off. That preventative care is what often keeps health problems from growing serious enough to merit an ER visit or hospital stay.

"We'll take care of you regardless of your insurance status," Mickiewicz said. "The real job is making sure people are healthy and don't need us."

Jocelyn Wiener from the California HealthCare Foundation Center for Health Reporting contributed to this report.