Bernard J. Wolfson
When the pinnacle of the nation’s largest publicly operated well being plan worries concerning the looming federal cuts to Medicaid, it’s not simply her job. It’s private.
Martha Santana-Chin, the daughter of Mexican immigrants, grew up on Medi-Cal, California’s model of Medicaid, the government-run well being care program for individuals with low incomes and disabilities. Today, she is CEO of L.A. Care, which runs by far the largest Medi-Cal well being plan, with greater than 2.2 million enrollees, exceeding the Medicaid and Children’s Health Insurance Program enrollments in 41 states.
“If it weren’t for safety nets like the Medi-Cal program, I think, many people would be stuck in poverty without an ability to get out,” she mentioned. “For me personally, not having to worry about health care allowed me to really focus on what I needed to focus on, which was my education.”
As she begins her second yr steering L.A. Care, Santana-Chin is grappling with federal and state spending cuts that complicate her process of offering well being care to the poor and medically susceptible enrollees in Medicaid. The insurer additionally supplies Affordable Care Act market plans by means of Covered California.
Santana-Chin warns that the GOP’s One Big Beautiful Bill Act, enacted final yr and also called HR 1, might lead to 650,000 enrollees falling off L.A. Care’s Medi-Cal rolls by the top of 2028. This will pressure the plan’s funds as revenues decline. The insurer had revenues of $11.7 billion within the final fiscal yr.
HR 1 is anticipated to chop greater than $900 billion from Medicaid over the following 10 years — together with $30 billion or more in California, based on the Department of Health Care Services, which runs Medi-Cal.
Like different states dealing with huge deficits, California has lowered its Medicaid spending by means of such steps as freezing new enrollments for immigrants with out authorized standing and reintroducing an asset limit. And that’s earlier than the state reckons with the spending cuts that seemingly will likely be required by the withdrawal of so many federal {dollars} underneath HR 1.
Santana-Chin oversaw Medi-Cal and Medicare operations for the for-profit insurer Health Net earlier than taking the helm of L.A. Care in January 2025, practically three years after state regulators fined L.A. Care $55 million over violations they mentioned compromised the well being and security of its members. L.A. Care paid $27 million in penalties to the state and agreed to contribute $28 million to neighborhood well being initiatives.
In a wide-ranging interview, Santana-Chin talked to KFF Health News senior correspondent Bernard J. Wolfson concerning the monetary headwinds dealing with L.A. Care and why she believes well being care shouldn’t be restricted based mostly on an individual’s immigration standing. This interview has been edited for size and readability.
Q: You grew up on Medicaid. How has that formed your views now that you just run one of many largest Medicaid plans within the nation?
What actually motivates me is understanding that most of the those who we’re serving are identical to my household. They’ve struggled and have needed to have their very own kids translate issues that had been very tough to translate. I bear in mind doing that for my very own mom. You know, primary human dignity requires that you’ve entry to well being care.
Q: Has something you’ve handled at Health Net or L.A. Care reminded you of your childhood experiences in Medi-Cal?
Back then they didn’t cowl transportation, and we didn’t have a car. Today, one of many points we’ll hear from our members is the necessity to ensure we’ve got reliable transportation that reveals up on time, the place the drivers deal with them with respect. Had I had that, had my mom had that, life would have been a lot simpler.
Q: What do you assume the impression of HR 1 will likely be?
It’s going to devastate the supply system. The state clearly isn’t going to have the ability to make up for the shortfalls in federal funding, and over the course of the following a number of years, funding goes to be much less and fewer, and the individuals we cowl are going to lower considerably. We expect between now and the top of 2028 that we’re going to see 650,000 individuals drop off the rolls. That’s simply L.A. Care.
Q: That’s over 1 / 4 of your Medi-Cal enrollment.
Yes, it’s very, very vital. The reductions in fee and the rise in uncompensated care are actually going to impression our supply system. As the supply system will get destabilized and hospitals and different well being care suppliers are compelled to shut companies or scale back the variety of websites they’ve, it’s going to impression entry. And it’s not solely going to impression those who lose protection.
Q: How will L.A. Care reply?
Obviously, we’re going to see a big drop in income. We’re very targeted on ensuring that we’re working as effectively as we are able to function. And we’re taking a look at inventive methods to make use of know-how to empower our individuals to do higher-level work. Mostly supporting our name heart brokers with smarter know-how that helps them reply questions and resolve issues extra rapidly. Some of it’s automating processes on the claims fee facet.
Q: What do it’s important to say to congressional Republicans who handed HR 1?
We are at some extent of inflection within the well being care supply system. And we’ve got to acknowledge that a few of the elements of HR 1 could have long-term unintended penalties — perhaps they had been meant; I’ve bought to consider that a few of these issues aren’t. There’s in all probability a must rethink a few of the issues that had been handed.
Q: Such as?
Work necessities are an instance of one thing that many individuals did consider was the proper factor to do to be good stewards of the well being care greenback. It may be very advanced and goes to trigger individuals to lose protection that really do qualify. It’s unlucky, and that will be one thing that I’d urge people to rethink.
Q: What impression do you anticipate from California’s choice to freeze Medi-Cal enrollment for immigrants with out authorized standing?
It doesn’t matter what immigration standing you might be. If you’re a human being and also you want well being care, you’re going to attempt to entry well being care wherever you may. That’s going to place a pressure on the supply system when you’re uninsured.
Q: What has L.A. Care executed to handle the state’s issues in 2022 that it delayed authorizing care and addressing affected person grievances?
There has been fairly a little bit of funding within the L.A. Care infrastructure during the last a number of years — our IT platforms, our information. There’s additionally fairly a little bit of funding in including new capability, including bandwidth to most of the groups, extra people to assist assist the work.
Q: How have federal immigration raids in L.A. affected L.A. Care members and the broader neighborhood?
It completely has had a chilling impact. Families are afraid to come back in. They’re not taking their kids to get vaccinated. I’ve had quite a few suppliers in emergency departments say that they’ve skilled a drop within the quantity of people coming in. One of our case managers was actually distraught as a result of there was a person that determined to forgo critical lifesaving therapy due to worry.
