Objective To investigate the current status and influencing factors of the utilization of medical assistance policy resources by difficult groups with chronic diseases and economic difficulties in urban villages, analyze the existing problems, and propose corresponding strategies to promote precision management of diseases for vulnerable groups and facilitate health poverty alleviation in the new era. Methods Firstly, using a questionnaire survey, two out of four urban village streets in a certain district of Chengdu were randomly selected to investigate the existing problems in the utilization of medical assistance by difficult groups. Secondly, telephone interviews were conducted to analyze the reasons for not utilizing medical assistance even though meeting the conditions, and countermeasures were proposed. Results Difficult groups utilized the policy of subsidizing and participating in insurance the best, while the utilization of outpatient, inpatient, and supplementary medical assistance policies was the worst. The results of multivariate Logistic regression analysis showed that having more than three comorbidities (OR=0.134) was a risk factor for assistance utilization. Having disabilities (OR=2.625), higher educational level (OR=3.500), and higher average monthly medical expenses (OR=4.148) were protective factors for utilization of assistance. The follow-up results indicated that factors such as patients’ lack of policy awareness, misunderstandings about policies, not seeking treatment at designated hospitals, some Chinese medicine not being reimbursed, and complex application procedures were the main causes leading to their non-utilization of policies. Conclusion Difficult groups with diseases utilize well the government assistance policies obtained through direct help, but the utilization of policies requiring proactive application is poor. The characteristics of patients’ own diseases, inadequate explanation of policies, high reimbursement thresholds, and limited reimbursement scope are the main reasons for difficult groups not applying for medical assistance.