A new California study has found that a federal requirement to check the citizenship of all Medi-Cal applicants has imposed significant burdens on California's 58 counties but that officials have not reported any cases of existing recipients who had falsely claimed U.S. citizenship. The study by the California Endowment and the California Healthcare Foundation found that the requirement in particular made it harder for the homeless, mentally ill, people born outside California, and children over age 16 to access public healthcare.