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 individuals with low incomes and disabilities. At present, 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 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 essentially concentrate on what I wanted to concentrate on, 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 weak enrollees in Medicaid. The insurer additionally gives 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 often known as HR 1, may lead to 650,000 enrollees falling off L.A. Care’s Medi-Cal rolls by the top 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 predicted 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 Providers, which runs Medi-Cal.
Like different states dealing with massive 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 is earlier than the state reckons with the spending cuts that seemingly shall 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, practically 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 tasks.
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 should not 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 just run one of many largest Medicaid plans within the nation?
What actually motivates me is realizing that lots of the those that 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 tough to translate. I bear 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 have handled at Well being Web 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 present, one of many points we’ll hear from our members is the necessity to verify 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 affect of HR 1 shall be?
It should 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 individuals we cowl are going to lower considerably. We expect between now and the top of 2028 that we will see 650,000 individuals 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 vital. The reductions in cost 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 compelled to shut providers or scale back the variety of websites they’ve, it will affect entry. And it is not solely going to affect people who lose protection.
Q: How will L.A. Care reply?
Clearly, we will 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. 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 cost facet.
Q: What do you must say to congressional Republicans who handed HR 1?
We’re at some extent of inflection within the well being care supply system. And now we have to acknowledge that a number of the parts of HR 1 may have long-term unintended penalties — possibly they have been meant; I’ve acquired to consider that a few of these issues are usually not. There’s in all probability a must 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 correct 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 is unlucky, and that may be one thing that I’d urge people to rethink.
Q: What affect do you count on from California’s resolution to freeze Medi-Cal enrollment for immigrants with out authorized standing?
It would not matter what immigration standing you’re. In case you are a human being and also you want well being care, you are going to attempt to entry well being care wherever you possibly can. That is 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 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 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. One in all our case managers was actually distraught as a result of there was a person that determined to forgo severe lifesaving therapy due to concern.