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 folks with low incomes and disabilities. Right now, 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 safety nets like the Medi-Cal program, I think, many people would be stuck in poverty without an ability to get out,” she stated. “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 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 Lovely Invoice Act, enacted final 12 months and also called HR 1, may lead to 650,000 enrollees falling off L.A. Care’s Medi-Cal rolls by the tip of 2028. This can 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 following 10 years — together with $30 billion or extra in California, in line with the Division of Well being Care Companies, which runs Medi-Cal.
Like different states going through huge deficits, California has diminished 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 shall be required by the withdrawal of so many federal {dollars} below 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, practically 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 initiatives.
In a wide-ranging interview, Santana-Chin talked to KFF Well being Information senior correspondent Bernard J. Wolfson concerning the monetary headwinds going through 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 figuring out that lots 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 bear 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 car. Right now, one of many points we’ll hear from our members is the necessity to verify we now have 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 suppose the influence of HR 1 shall 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 folks we cowl are going to lower considerably. We expect 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 vital. The reductions in fee and the rise in uncompensated care are actually going to influence our supply system. Because the supply system will get destabilized and hospitals and different well being care suppliers are compelled to shut providers or scale back the variety of websites they’ve, it’s going to influence entry. And it’s not solely going to influence those who lose protection.
Q: How will L.A. Care reply?
Clearly, we’re going to see a big drop in income. We’re very targeted on ensuring that we’re working as effectively as we will function. And we’re taking a look at artistic methods to make use of expertise to empower our folks 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 facet.
Q: What do you must 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 few of the parts of HR 1 can have long-term unintended penalties — perhaps they have been meant; I’ve acquired to imagine that a few of these issues usually are not. There’s in all probability a have to rethink a few of the issues that have been handed.
Q: Reminiscent of?
Work necessities are an instance of one thing that many individuals did imagine was the best factor to do to be good stewards of the well being care greenback. It is vitally complicated and goes to trigger folks to lose protection that really do qualify. It’s unlucky, and that might be one thing that I might urge people to rethink.
Q: What influence do you count on 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. 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 possibly can. That’s going to place a pressure on the supply system if you happen to’re uninsured.
Q: What has L.A. Care completed 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 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 lots of the groups, extra people 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 in all our case managers was actually distraught as a result of there was a person that determined to forgo critical lifesaving remedy due to worry.
