Another resident at the Randy Sams' shelter, Ed Miller, 42, has congestive heart failure and sleep apnea. Recently, he went to the hospital and received a diagnosis of bronchitis too. Asked if he would consider moving to Arkansas to gain access to Medicaid, he responded, "I might look into that."
The shelter helps its residents gain access to the government programs they are eligible for: food stamps, Social Security, disability, housing vouchers when available. Once, Ms. Laurent said, an Arkansas social worker came across the state line to see if anyone might be eligible for the Medicaid expansion.
But even many qualified people resist using government services, because of fear, a lack of knowledge or a criminal conviction. "They just don't trust the government," Ms. Laurent said. "They've been told no over and over and over again."
And moving even a few blocks away might pose an insurmountable challenge. The Salvation Army shelter on the Arkansas side of town charges $6 a night, more than many of the very poor can afford. Randy Sams', on the Texas side, is free.
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"I tell my clients: You've got to have paper, or you've got to have paper," Ms. Laurent said. "You've got to have money, or you're going to have to fill out a lot of paperwork for benefits."
Mr. Tramel said he walked to Texas from Missouri, finding God and kicking a drug habit along the way. The trip took him 11 days. He has no Social Security card, birth certificate or driver's license, let alone a stable address. The paperwork challenge of establishing residency in a state and applying for benefits, he said, seemed overwhelming to him.