Federal Records Weight Medicaid Enrollment Accordingly, Executive Director of Largest Public Health Plan

When the director of the nation’s largest public health plan expresses concern for prominent federal Medicaid doctors, he only does so because it’s about his job. It’s something personal.

Martha Santana-Chin, daughter of Mexican immigrants, created Medi-Cal, California’s version of Medicaid, the government-administered medical assistance program for people with low income and reduced abilities.

Today, he is CEO of LA Care, which administers, by far, the largest Medi-Cal plan, with more than 2.2 million beneficiaries, exceeding the number of enrollments in Medicaid and the Infant Health Program (CHIP, for its acronym in English) in 41 states.

“If there is no way to adapt to the medical program, many people are in contact with the population without the possibility of exiting effectively,” he said. “On a personal level, I don’t have to worry about medical attention to allow me to focus on what I need to do: my education.”

At the start of LA Care’s second year, Santana-Chin received reports of federal and state assumptions that make it difficult to provide medical care to low-income, medically vulnerable people enrolled in Medicaid. The insurer also offers La Ley de Cuidado de Salud à Bajo Precio (ACA) plans across covered California.

Santana-Chin said Republican legislation passed in the form of the One Big Beautiful Bill Act, approved last year and also called HR 1, could cause 650,000 people to be saved from LA Care’s Medi-Cal program before the end of 2028. This will affect the plan’s finances due to reduced revenue. The insurer reported earnings of $11,700 million in the last fiscal year.

HR 1 is estimated to save more than $900,000 million from Medicaid in the next 10 years, including more than $30,000 million in California, according to the state Department of Medical Assistance Services, which administers Medi-Cal.

Like other states with large deficits, California has reduced its Medicaid spending through measures to freeze new registrations of immigrants without legal status and to impose a new activity limit. All of this is also before the state objected to cases derived from the loss of federal funds under HR 1.

Santana-Chin began carrying Medi-Cal and Medicare operations for Health Net private insurance, before assuming leadership of LA Care in January 2025. The haul began three years ago after regulators established a connection with LA Care with $55 million for violations that it said jeopardized the health and safety of its members. LA Care paid $27 million in installments to the state and awarded $28 million to community health projects.

In a wide-ranging conversation, Santana-Chin spoke with Bernard J. Wolfson, senior correspondent for KFF Health News, about the financial challenges facing LA Care and why they believe medical attention should not depend on a person’s immigration status. This interview has been edited for space and clarity.

You were created with Medicaid. How have you influenced this vision now leading one of the largest aircraft in the country?
What really motivates me is that many people serve us like family. He faced difficulties and insisted on depending on his own children to translate some very complicated things. I told you, I made it for my mom. Basic human dignity requires access to medical attention.

Is there anything in your work at Health Net or LA Care that recorded your childhood experience with Medi-Cal?
And therefore no sea transport and no car. Today, one of the reasons we listen to our friends is the need to contact reliable transportation, which gets us there on time and makes us drive the treaty with respect. If my mother and I experienced this, life should be a lot easier.

What impact will HR 1 have?
This will devastate the medical care system. It will then be impossible to compensate for the loss of federal funds, and in the years to come, there will be less and less money. This is why the number of people we chose is reduced significantly. We hope that between now and the 2028 fines, a total of 650,000 people will be declared on our list. Yes, it’s solo in LA Care.

This represents more than a quarter of your Medi-Cal affiliates
Yes, it is very significant. Reducing payments and increasing attention will be unpaid and will seriously affect the system. As this system is weakened, hospitals and other providers are forced to reduce services or downsize their centers, access to attention will be affected. Y no solo para quienes pierdan la cobertura.

How do I respond to LA Care?
We are obviously going to have a significant increase in contributions. We are very capable of operating in the most efficient manner possible. We are ready to get creative using technology so our staff can reach next-level levels. For example, improve our tools so call center agents can respond faster and resolve issues. We are also able to automate payment area processes.

¿What does it say to the republicans of Congress that approved HR 1?
We are at an inflection point in the health care system. We need to recognize that some parts of HR 1 either don’t have desired consequences on a large scale, or they were already desired, but I think it’s happening. There are probably aspects worth reconsidering.

What are these?
Work requirements are an example. We very much believe that this will be a good form of responsible administrator of the money intended for health. But it’s much more complex and provocative than people who are really being determined to get their cover. This is lamentable, and it is also something that should be reconsidered.

What impact will California’s decision to freeze medical enrollment for immigrants without legal status have?
It’s not important for your immigration status, if you’re a human being and need medical attention, you’re going to have to get it done. Yes, it will put strain on the system if you are unsure.

What has LA Care chosen to address the state’s concerns in 2022 regarding requests for authorization of services and attention to affected individuals?
There have been a lot of inversions in LA Care’s infrastructure over the past few years: in our technology platforms, in the data process. It also has a large capacity, it has strengthened a lot of equipment, and it is more personal to do the work.

How has it affected federal migration rules in Los Angeles by LA Care affiliates and the community at large?
It definitely had a chilling effect. The family is in the middle of a doctor. You are not able to vaccinate your children. Many providers in emergency rooms told us they have reduced the number of people they see. One of our case managers became very angry because a person decided not to receive life-saving treatment for him.

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