The state plans to train and certify 20,000 enrollment counselors and 12,000 insurance agents who will be able to explain options to consumers and help them enroll. But so far, just a tiny fraction of those helpers have received official approval, leaving consumers to either sign up on their own through the Web site or state hot line or wait.

The state in some ways had a head start, expanding Medicaid since 2010. Like those at other clinics throughout the state, outreach workers at Eisner and St. John’s helped hundreds of patients enroll in an expanded county-run health insurance plan as part of the Medicaid expansion. Most of those patients will be switched automatically to Medi-Cal, the state-run insurance program, in January.

Many say the most difficult challenge will come in reaching people who earn too much to qualify for Medicaid, but are eligible for subsidies on the exchange. “I’ve looked at it a bit, but to be honest with you I’m just confused,” said Danielle Waldby, 29, a college graduate who now works as a part-time nanny and dog walker. Ms. Waldby suffered a ruptured abdominal abscess last year, and doctors recommended she follow up with a colonoscopy, a procedure that she said would cost her at least $7,000. By chance, Ms. Waldby had an annual exam at the Eisner clinic on the same day the new health care law went into effect and her doctor urged her to meet with an enrollment counselor, who promised to help once approval from the state came through. “I started to look online, but there’s all kinds of jargon I don’t understand.”

Even as they point out the problems, health care providers who have cared for low-income patients for years are reluctant to heap criticism on the state.

“There’s a big cheerleading effort, this is an amazing thing that’s happening, truly historical and truly a change of how we perceive health care,” said Deb Farmer, the president and chief executive of Westside Family Health Center, a community clinic in Santa Monica. “Perhaps things didn’t happen as quickly as they may have because there was so much uncertainty and this is a massive undertaking. The expectations for Oct. 1 were a little unrealistic, to say the least.”

Staff members were unable to attend three-day training programs run by the state for enrollment counselors until mid-September, Ms. Farmer said, making it impossible to actually enroll people last week. As of Monday, just one staff member had received certification from the state. Ms. Farmer said the clinic, like many other local groups, expected to increase its efforts in November. “We’re going to spend this time making sure we understand whatever quirks there are in the system so that once we get going, we know exactly what to do,” she said.