When the top 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. As we speak, 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 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 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 offers Inexpensive Care Act market plans via Coated California.
Santana-Chin warns that the GOP’s One Massive Stunning 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 subsequent 10 years — together with $30 billion or extra in California, in response to the Division of Well being Care Companies, which runs Medi-Cal.
Like different states dealing with large deficits, California has decreased its Medicaid spending via 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 Internet 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 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 simply run one of many largest Medicaid plans within the nation?
What actually motivates me is understanding 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 youngsters translate issues that had been very troublesome to translate. I bear in mind doing that for my very own mom. You already know, primary human dignity requires that you’ve got 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 automobile. As we speak, 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 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 subsequent a number of years, funding goes to be much less and fewer, and the individuals we cowl are going to lower considerably. We predict 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 important. 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 pressured to shut companies or cut back the variety of websites they’ve, it’s going to influence entry. And it’s not solely going to influence 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 are able to function. And we’re inventive methods to make use of expertise to empower our individuals to do higher-level work. Principally 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 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 we’ve got to acknowledge that among the elements of HR 1 may have long-term unintended penalties — possibly they had been meant; I’ve bought to consider that a few of these issues should not. There’s most likely a have to rethink among the issues that had been handed.
Q: Resembling?
Work necessities are an instance of one thing that many individuals did consider was the precise 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 truly do qualify. It’s unlucky, and that may 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’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 may. That’s going to place a pressure on the supply system if you happen to’re uninsured.
Q: What has L.A. Care finished to handle 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 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 lots 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 group?
It completely has had a chilling impact. Households are afraid to come back in. They’re 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. Certainly 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 concern.