For 13-year-old Devin Vallejo of Oildale, visiting a specialist for his juvenile diabetes means a two-hour drive each way to the children's hospital in Madera.
For Pamela and Mike Mayfield, his grandparents and legal guardians, each trip also means spending scarce money to rent a car.
Devin is covered by Medi-Cal, a publicly funded health program for low-income and disabled residents. But he also joins a group of children with serious medical conditions -- including hemophilia and cerebral palsy -- who receive some medical care through a different public program called California Children's Services (CCS).
Devin was referred to a pediatric endocrinologist at Children's Hospital Central California in Madera because the family was told that was the closest specialist who accepts Devin's complicated mix of insurance, said Pamela, 52.
"We have no diabetes doctor for children like Devin in Bakersfield. Unless you have good insurance, then you can go to any doctor here," she said. "If there's an emergency, it's not like I can jump in the car and go to Madera."
Devin, an eighth grader at Standard Middle School, takes insulin shots four times a day. A sometimes brooding teen, he doesn't always admit to his grandmother when he has eaten a donut or other sweet treat that sends both his blood sugar -- and her blood pressure -- soaring.
When asked how he feels about traveling to Madera at least four times a year for appointments, Devin uses a few choice words such as "lame" and "sucks" at first, then elaborates.
"There should be no such thing as Medi-Cal. It should be equal," he said. "Why can't it be close? Why does it have to be far?"
Like Devin, about 70 percent of CCS-eligible kids also are eligible for Medi-Cal. The Medi-Cal program reimburses their care.
Finding a Medi-Cal doctor can be challenging enough. But kids on CCS have to go one step further and find specialists in the CCS network, according to the state Department of Health Care Services.
Those doctors have the most specialized training and skills to treat CCS-covered diseases, said Anthony Cava, department spokesman.
"It may not be in Kern County, but it's the best care the child is going to receive," he said.
The Mayfields have a truck, but it needs work and can't be trusted for the drive to Madera. Fixing it is beyond the reach for the one-income family, Pamela said.
"We've missed appointments quite a few times because of transportation," she said.
Devin's last appointment in Madera was in November. His next is in February. Pamela plans to rent a car "unless by the grace of god we come up with god knows how much money to fix our car," she said.
The trips also take a physical -- and emotional -- toll on the family.
"I have to get up at 4 or 5 a.m. sometimes," Devin said. "One time we went to Madera and we were just in and out in, like, 15 minutes. It was like no point in even going."
"I would rather see a doctor here," he added.