Among the hardest hit are doctors who provide services to the poor, whose Medi-Cal program payments will be cut by 10 percent, and California's public schools, which will not receive about $500 million they had expected.

The cuts are almost certain to have dramatic impacts on area school districts struggling to assemble balanced budgets. The ramifications could include teacher layoffs, higher fees for families and deep cuts to student programs.

In addition to proposing a $400 million mid-year education cut, Gov. Schwarzenegger has proposed taking $4.4 billion of education funding out of the budget for the fiscal year starting July 1. 

"There's no pretty way to describe the horrible budget gap that California faces. We've got to do the best we can," said Assembly Speaker Fabian Nunez, D-Los Angeles.

That was little consolation for dozens of Rialto teachers and parents who protested the possible elimination of more than 400 positions at Wednesday evening's school board meeting.

"It's unconscionable," said Rialto kindergarten teacher Sandra Booker. Rialto school officials plan to notify 400 of the district's 1,450 teachers and counselors that they may not have a job next year. The biggest impact of the potential layoffs would be felt in kindergarten through third grade where the student-teacher-ratio could jump from a mandated 20 students to 1 teacher to 32.  

Two weeks ago, a child with flu-like symptoms was sent from her first grade class to a specialty group for care.  When the family got to the front desk, they were told the doctor would not see the child because the office doesn't accept Medi-Cal patients.

The California Medical Association which represents thousands of doctors who treat the poor, called the 10% Medi-Cal rate cut inhumane and devastating.  “Medi-Cal patients will be forced into emergency rooms for their primary care, driving up costs and compromising access to emergency services for all Californians.”

By the time the child went to a local emergency room the next day, a massive infection had affected her breathing and she needed emergency surgery.

Healthcare experts worry this kind of scenario will become more common as doctors who treat the poor brace for a 10% Medi-Cal rate cut.

The cut will leave millions of Californians stranded with reduced or no access to their critical health care needs warns the California Medical Association (CMA) which represents thousands of doctors who treat the poor and disabled.

"Medi-Cal patients will be forced into emergency rooms for their primary care, driving up costs and compromising access to emergency services for all Californians," said  CMA President Richard Frankenstein, M.D.  

The Medi-Cal program is seriously underfunded already, with only about half of the physicians in the state taking Medi-Cal payments. Many cannot afford to take new patients because reimbursements don't cover the cost of care. Under current Medi-Cal rates, a primary care office visit goes for $12 to $20, for example, which doesn't cover the cost of a physician's time, overhead or other expenses.  Current Medi-Cal rates are some of the lowest in the nation, and are, on average, 60 percent of Medicare and less than 50 percent of commercial health plan rates.

"Legislators need to give more consideration than a hearing or two, to the impact these cuts will have on all Californians," said Dr. Frankenstein.

"Day after day I see members of working class families who walk into our clinic begging for care. We see disabled seniors dying from treatable cancer and heart disease, pregnant teens that go without prenatal care. We're bracing for a huge impact," said Temetry Lindsey. She warns dentists who treat the poor will be among the first to abandon the Medi-Cal program.

"It's a no-brainer" - fewer than 30 percent of Inland dentists are taking new patients, said Lindsey - "that was before this new wave of cuts." 

The likely effects of these cuts was highlighted last week in Los Angeles, where county health officials announced the proposed closure of all but one of the county's dozen clinics. LA will also drastically reduce services at six outpatient health centers, a move Lindsey says will put pressure on Inland health providers.

"Those patients will undoubtedly seek care elsewhere," said Lindsey. "The Inland Empire is now on their radar."