Understanding the Affordable Care Act can be a challenge for health-policy experts, let alone for the thousands of Californians seeking to sign up for health insurance.

Imagine trying to decipher the process if your only language were Singhalese.

State agencies and social service organizations have made highly publicized attempts to include non-English-speaking immigrants in either the Medi-Cal expansion or Covered California. In addition to English, officials have prepared materials on health reform in a dozen languages, trying to inform the state’s largest immigrant populations.

But with more than 200 languages spoken in California, there’s concern that smaller populations might not get needed health care information.

That’s where groups like the South Asian Network come in. The Artesia-based nonprofit, which serves immigrants from India, Bangladesh, Pakistan, Nepal and Sri Lanka, sends teams to community, business and religious centers in immigrant communities throughout Southern California, trying to get the word out on the Affordable Care Act.

Recently a SAN team set up a table at the Bharat Community Center in Irvine for Diwali, the Hindu “Festival of Lights.”

Within the first hour, five people had asked for help in obtaining insurance, said Manjusha Kulkarni, SAN’s executive director.

She said in addition to language difficulties, there are cultural barriers. People from South Asia are often described as prosperous “model minorities,” and an estimated 80 percent of immigrants from these countries reportedly have private health insurance. But that leaves 20 percent who don’t meet the sunny stereotype, and are confused about what insurance options they may have, Kulkarni said.

“There have been many cases where I’ve gone to do outreach and people will just take a brochure. They won’t say a word to us, but then they’ll call us the following Monday,” she said.

“They don’t want other folks to know that they lack health insurance and that they’re not doing well financially.”

Vhar Balasubramanian said she’s insured through her husband’s company plan, but she took some of Kulkarni’s pamphlets to give to women she knows whose spouses have left them. Suddenly, they’ve found themselves without health insurance or the language skills to seek coverage, Balasubramanian said.

“Most of the government healthcare things, they have a Spanish-speaking person to help, but when we go as an Indian, and then the person can’t speak the language, they’re just totally lost,” she said.

James Scullary, a spokesman for the state insurance exchange, Covered California, said the state has prepared materials in the “Medi-Cal threshold languages,” defined as languages spoken by at least 20,000 or more limited English-proficient health consumers in California. Those are Arabic, Armenian, Chinese, Farsi, Hmong, Khmer, Korean, Lao, Russian, Spanish, Tagalog, and Vietnamese.

According to a recent study by the Asian American Center for Advancing Justice, California’s South Asians make up the fastest-growing immigrant population in the state. From 2000 to 2010, for instance, the number of Bangladeshi immigrants doubled. But total populations remain small. In 2010, the census counted just 10,494 immigrants from Bangladesh in the state. The number of Sri Lankan immigrants was similarly small.

“California’s an enormous state, with people from all over the world. We started with the biggest languages which we knew affected the most people, and we have plans to continue to add to those,” Scullary said.

“I don’t know where Sri Lanka and Bangladesh are on that list.”

To help reach smaller populations, the exchange has distributed $40 million in grants to community-based organizations, faith-based groups, nonprofits and local governments for outreach and education efforts, he said.

SAN received a grant in July, Kulkarni said. Since then, the organization has helped some 1,000 people to apply for coverage, she said.

Educational support is as important as assistance with applications, Kulkarni added. She remembers a 73-year-old Bangladeshi man who thought he needed help applying for Covered California. When then he took out his wallet and showed a SAN worker his Medi-Cal card.

“He didn’t know that that was his access to a healthcare provider,” Kulkarni said.

Doreena Wong, who promotes health access for immigrants at the Asian American Center for Advancing Justice, sees a need for more translation of simple explanatory materials. Many of the documents that have been translated into one of the Medi-Cal threshold languages are fairly sophisticated and specialized, not broadly useful to people trying to grasp basic information, Wong said.

“We are using the other materials as well because we don’t have a choice, “ she said, adding that her organization is negotiating with Covered California over procedures for translating more understandable materials.

She said AACAJ’s partners are proceeding with verbal coaching while waiting for Covered California to approve translations.

Cary Sanders, director of policy analysis for the California Pan-Ethnic Health Network, an Oakland-based advocacy group, welcomed the Covered California grant program. She also strongly supports the health exchange’s contract with a private translation service that can offer help in hundreds of languages to people who call the Covered California hotline.

“We’ll be looking to make sure that they’re able to serve California’s diverse communities,” she said. “They’re certainly making a strong attempt.”