When the pinnacle of the nation’s largest publicly operated well being plan worries in regards to 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 folks with low incomes and disabilities. At present, she is CEO of L.A. Care, which runs by far the most important Medi-Cal well being plan, with greater than 2.2 million enrollees, exceeding the Medicaid and Kids’s Well being Insurance coverage Program enrollments in 41 states.
“If it weren’t for security nets just like the Medi-Cal program, I believe, many individuals can be caught in poverty with out a capability to get out,” she stated. “For me personally, not having to fret about well being care allowed me to essentially deal with what I wanted to deal with, which was my training.”
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 gives Inexpensive Care Act market plans by means of Coated California.
Santana-Chin warns that the GOP’s One Huge Stunning Invoice 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 tip of 2028. It 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 predicted to chop greater than $900 billion from Medicaid over the subsequent 10 years — together with $30 billion or extra in California, in accordance with the Division of Well being Care Companies, which runs Medi-Cal.
Like different states going through large deficits, California has decreased its Medicaid spending by means of such steps as freezing new enrollments for immigrants with out authorized standing and reintroducing an asset restrict. And that’s earlier than the state reckons with the spending cuts that doubtless can 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 Well being Internet earlier than taking the helm of L.A. Care in January 2025, almost three years after state regulators fined L.A. Care $55 million over violations they stated 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 group well being tasks.
In a wide-ranging interview, Santana-Chin talked to KFF Well being Information senior correspondent Bernard J. Wolfson in regards to the monetary headwinds going through L.A. Care and why she believes well being care shouldn’t be restricted primarily based 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 simply run one of many largest Medicaid plans within the nation?
What actually motivates me is figuring out that most of the people who we’re serving are similar to my household. They’ve struggled and have needed to have their very own kids translate issues that have been very troublesome to translate. I keep in mind doing that for my very own mom. You already know, fundamental human dignity requires that you’ve entry to well being care.
Q: Has something you’ve handled at Well being Internet or L.A. Care reminded you of your childhood experiences in Medi-Cal?
Again then they didn’t cowl transportation, and we didn’t have a car. At present, one of many points we’ll hear from our members is the necessity to ensure now we have reliable transportation that exhibits 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 suppose the impression of HR 1 can 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 subsequent a number of years, funding goes to be much less and fewer, and the folks we cowl are going to lower considerably. We predict between now and the tip of 2028 that we’re going to see 650,000 folks drop off the rolls. That’s simply L.A. Care.
Q: That’s over 1 / 4 of your Medi-Cal enrollment.
Sure, it’s very, very important. The reductions in fee and the rise in uncompensated care are actually going to impression our supply system. Because the supply system will get destabilized and hospitals and different well being care suppliers are pressured to shut companies or cut 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?
Clearly, we’re going to see a major drop in income. We’re very centered on ensuring that we’re working as effectively as we are able to function. And we’re inventive methods to make use of know-how to empower our folks to do higher-level work. Principally supporting our name heart brokers with smarter know-how that helps them reply questions and resolve issues extra shortly. A few 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’re at a degree of inflection within the well being care supply system. And now we have to acknowledge that a few of the elements of HR 1 may have long-term unintended penalties — perhaps they have been meant; I’ve obtained to consider that a few of these issues usually are not. There’s most likely a must rethink a few of the issues that have been handed.
Q: Equivalent to?
Work necessities are an instance of one thing that many individuals did consider was the fitting factor to do to be good stewards of the well being care greenback. It is rather complicated and goes to trigger folks to lose protection that really do qualify. It’s unlucky, and that may be one thing that I’d urge of us to rethink.
Q: What impression do you count on from California’s resolution to freeze Medi-Cal enrollment for immigrants with out authorized standing?
It doesn’t matter what immigration standing you’re. In case you are a human being and also you want well being care, you’re going to attempt to entry well being care wherever you’ll be able to. That’s going to place a pressure on the supply system when you’re uninsured.
Q: What has L.A. Care performed to deal with the state’s issues in 2022 that it delayed authorizing care and addressing affected person grievances?
There was fairly a little bit of funding within the L.A. Care infrastructure over the past a number of years — our IT platforms, our knowledge. There’s additionally fairly a little bit of funding in including new capability, including bandwidth to most of the groups, extra of us to assist help the work.
Q: How have federal immigration raids in L.A. affected L.A. Care members and the broader group?
It completely has had a chilling impact. Households 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 among our case managers was actually distraught as a result of there was a person that determined to forgo severe lifesaving therapy due to worry.
