When the top of the nation’s largest publicly operated well being plan worries concerning the looming federal cuts to Medicaid, it is not simply her job. It is 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 the moment, 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 Youngsters’s Well being Insurance coverage Program enrollments in 41 states.
“If it weren’t for security nets just like the Medi-Cal program, I feel, many individuals could 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 actually give attention to what I wanted to give attention to, which was my training.”
As she begins her second 12 months steering L.A. Care, Santana-Chin is grappling with federal and state spending cuts that complicate her job of offering well being care to the poor and medically susceptible enrollees in Medicaid. The insurer additionally gives Inexpensive Care Act market plans by Coated California.
Santana-Chin warns that the GOP’s One Huge Lovely Invoice Act, enacted final 12 months and also referred to as HR 1, may lead to 650,000 enrollees falling off L.A. Care’s Medi-Cal rolls by the tip of 2028. This may 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 keeping with the Division of Well being Care Providers, which runs Medi-Cal.
Like different states going through huge deficits, California has decreased its Medicaid spending by such steps as freezing new enrollments for immigrants with out authorized standing and reintroducing an asset restrict. And that is earlier than the state reckons with the spending cuts that probably can 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 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 neighborhood 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 should not 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 realizing that most of the those who we’re serving are similar to my household. They’ve struggled and have needed to have their very own youngsters translate issues that have been very troublesome to translate. I bear in mind doing that for my very own mom. You realize, fundamental human dignity requires that you’ve got entry to well being care.
Q: Has something you have handled at Well being Internet or L.A. Care reminded you of your childhood experiences in Medi-Cal?
Again then they did not cowl transportation, and we did not have a automobile. At the moment, one of many points we’ll hear from our members is the necessity to verify we’ve got 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’ll devastate the supply system. The state clearly is not 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 predict between now and the tip of 2028 that we’ll see 650,000 folks drop off the rolls. That is simply L.A. Care.
Q: That is over 1 / 4 of your Medi-Cal enrollment.
Sure, it is very, very important. The reductions in cost 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 scale back the variety of websites they’ve, it is going to impression entry. And it is not solely going to impression those who lose protection.
Q: How will L.A. Care reply?
Clearly, we’ll 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 rapidly. A few of it’s automating processes on the claims cost aspect.
Q: What do it’s important to say to congressional Republicans who handed HR 1?
We’re at some extent of inflection within the well being care supply system. And we’ve got to acknowledge that a number of the elements of HR 1 may have long-term unintended penalties — possibly they have been meant; I’ve bought to imagine that a few of these issues usually are not. There’s in all probability a must rethink a number of the issues that have been handed.
Q: Akin to?
Work necessities are an instance of one thing that many individuals did imagine was the appropriate factor to do to be good stewards of the well being care greenback. It is vitally advanced and goes to trigger folks to lose protection that really do qualify. It is 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 would not matter what immigration standing you might be. If you’re a human being and also you want well being care, you are going to attempt to entry well being care wherever you may. That is going to place a pressure on the supply system in case you’re uninsured.
Q: What has L.A. Care achieved to deal with 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 knowledge. 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. Households are afraid to come back in. They are not taking their youngsters 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. Considered one of our case managers was actually distraught as a result of there was a person that determined to forgo severe lifesaving remedy due to worry.
