When the top 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 individuals with low incomes and disabilities. As we speak, 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 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 mentioned. “For me personally, not having to fret about well being care allowed me to actually deal with what I wanted to deal with, which was my schooling.”
As she begins her second 12 months steering L.A. Care, Santana-Chin is grappling with federal and state spending cuts that complicate her activity of offering well being care to the poor and medically weak enrollees in Medicaid. The insurer additionally supplies Inexpensive Care Act market plans by way of Lined California.
Santana-Chin warns that the GOP’s One Large Stunning Invoice Act, enacted final 12 months and also called HR 1, might end in 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 12 months.
HR 1 is anticipated 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 Providers, which runs Medi-Cal.
Like different states dealing with huge deficits, California has lowered its Medicaid spending by way 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 possible might be required by the withdrawal of so many federal {dollars} beneath HR 1.
Santana-Chin oversaw Medi-Cal and Medicare operations for the for-profit insurer Well being Web 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 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 group well being initiatives.
In a wide-ranging interview, Santana-Chin talked to KFF Well being Information senior correspondent Bernard J. Wolfson in regards to the monetary headwinds dealing with 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 realizing that most of the folks that 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 tough to translate. I keep in mind doing that for my very own mom. You understand, fundamental human dignity requires that you’ve got entry to well being care.
Q: Has something you’ve handled at Well being Web 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 automobile. As we speak, one of many points we’ll hear from our members is the necessity to verify we now 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 assume the affect of HR 1 might 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 individuals we cowl are going to lower considerably. We expect between now and the tip 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.
Sure, it’s very, very vital. The reductions in fee and the rise in uncompensated care are actually going to affect our supply system. Because the supply system will get destabilized and hospitals and different well being care suppliers are pressured to shut providers or scale back the variety of websites they’ve, it’s going to affect entry. And it’s not solely going to affect people who lose protection.
Q: How will L.A. Care reply?
Clearly, we’re going to see a major drop in income. We’re very targeted on ensuring that we’re working as effectively as we will function. And we’re inventive methods to make use of expertise to empower our individuals to do higher-level work. Largely supporting our name heart brokers with smarter expertise that helps them reply questions and resolve issues extra shortly. A few of it’s automating processes on the claims fee aspect.
Q: What do it’s a must to say to congressional Republicans who handed HR 1?
We’re at a degree of inflection within the well being care supply system. And we now have to acknowledge that a number of the elements of HR 1 can have long-term unintended penalties — possibly they have been supposed; I’ve acquired to consider that a few of these issues will not be. There’s most likely a have to rethink a number of the issues that have been handed.
Q: Similar to?
Work necessities are an instance of one thing that many individuals did consider was the best factor to do to be good stewards of the well being care greenback. It is vitally advanced and goes to trigger individuals to lose protection that really do qualify. It’s unlucky, and that might be one thing that I’d urge of us to rethink.
Q: What affect 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’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 in case you’re uninsured.
Q: What has L.A. Care accomplished to handle the state’s considerations 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 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 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 critical lifesaving therapy due to concern.
