GOP cuts will cripple Medicaid enrollment, CEO of largest public health plan warns

When the head of the nation’s largest public health plan worries about looming federal cuts to Medicaid, it’s not just about her job. It’s personal.

Martha Santana-Chin, the daughter of Mexican immigrants, grew up on Medi-Cal, California’s version of Medicaid, the government-run health care program for low-income and disabled people. Today, she is CEO of LA Care, which operates by far the largest Medi-Cal health plan, with more than 2.2 million enrollees, surpassing Medicaid and Children’s Health Insurance Program enrollment in 41 states.

“If there were no safety nets like the Medi-Cal program, I think many people would be stuck in poverty with no way out,” she said. “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 enters her second year leading LA Care, Santana-Chin is grappling with federal and state spending cuts that complicate her job of providing health care to poor and medically vulnerable Medicaid enrollees. The insurer also offers Affordable Care Act marketplace plans through Covered California.

Santana-Chin warns that the GOP’s One Big Beautiful Bill Act, signed into law last year and also known as HR 1, could cause 650,000 enrollees to disappear from LA Care’s Medi-Cal rolls by the end of 2028. That will strain the plan’s finances as revenues decline. The insurer had revenue of $11.7 billion in the last financial year.

HR 1 is expected to cut more than $900 billion from Medicaid over the next 10 years, including $30 billion or more in California, according to the Department of Health Services, which administers Medi-Cal.

Like other states facing large deficits, California has reduced its Medicaid spending by taking steps such as freezing new enrollment for immigrants without legal status and reintroducing an assets limit. And that’s before the state takes into account the spending cuts that will likely be necessary due to the withdrawal of so many federal dollars under HR 1.

Santana-Chin oversaw Medi-Cal and Medicare operations for for-profit insurer Health Net before taking the helm of LA Care in January 2025, nearly three years after state regulators fined LA Care $55 million for violations they said jeopardized the health and safety of its members. LA Care paid $27 million in penalties to the state and agreed to contribute $28 million to community health projects.

In a wide-ranging interview, Santana-Chin spoke to KFF Health News Senior Correspondent Bernard J. Wolfson about the financial challenges facing LA Care and why she believes health care should not be restricted based on a person’s immigration status. This interview has been edited for length and clarity.

Q: You grew up on Medicaid. How has that shaped your perspective now that you lead one of the nation’s largest Medicaid plans?

What really motivates me is knowing that many of the people we serve are like family to me. They struggled and had to ask their own children to translate things that were very difficult to translate. I remember making this for my own mother. You know, basic human dignity requires that you have access to health care.

Q: Has anything you experienced at Health Net or LA Care reminded you of your childhood experiences at Medi-Cal?

At the time, they didn’t cover transportation and we didn’t have a vehicle. One of the issues our members will present to us today is the need to ensure we have reliable transportation that arrives on time and where drivers treat them with respect. If I had that, if my mother had that, life would have been a lot easier.

Q: What impact do you think HR 1 will have?

This will devastate the delivery system. The state will obviously not be able to close the federal funding gap, and over the next few years funding will be less and less and the number of people we cover will decline significantly. We predict that by the end of 2028, 650,000 people will disappear from the lists. It’s just LA Care.

Q: This represents more than a quarter of your Medi-Cal enrollment.

Yes, it is very, very important. Payment reductions and increases in uncompensated care will really impact our delivery system. As the delivery system destabilizes and hospitals and other healthcare providers are forced to close their services or reduce the number of sites they have, this will impact access. And it won’t just impact those who lose coverage.

Q: How will LA Care respond?

Obviously, we’re going to see a significant drop in revenue. We ensure that we operate as efficiently as possible. And we’re exploring creative ways to use technology to enable our people to do higher-level work. Primarily supporting our call center agents with smarter technology that helps them answer questions and resolve issues faster. This is partly about automating the processes related to claims payment.

Q: What do you have to say to the congressional Republicans who passed HR 1?

We are at an inflection point in the health care delivery system. And we must recognize that some elements of HR 1 will have unintended long-term consequences – perhaps they were intended; I have to believe that some of these things aren’t. It is probably necessary to reconsider some of the things that have been adopted.

Q: Like?

The job requirements are an example of what many people believed was the right thing to do to manage health care dollars well. It’s very complex and it will cause people to lose coverage that they are actually eligible for. This is unfortunate, and something I would urge people to reconsider.

Q: What impact do you expect from California’s decision to freeze medical registrations for immigrants without legal status?

It doesn’t matter your immigration status. If you are a human being and you need health care, you are going to try to access health care wherever you can. This will put a strain on the delivery system if you are not insured.

Q: What has LA Care done to address the state’s concerns in 2022 that it has delayed authorizing care and addressing patient grievances?

Many investments have been made in LA Care’s infrastructure over the past few years: our IT platforms, our data. There is also a lot of investment in adding new capabilities, adding bandwidth to many teams, and more people to help support the work.

Q: How have federal immigration raids in Los Angeles affected LA Care members and the community as a whole?

It absolutely had a deterrent effect. Families are afraid to enter. They don’t take their children to get vaccinated. Many emergency service providers reported seeing a drop in the number of people arriving. One of our case managers was truly distraught because a person decided to forgo serious, life-saving treatment out of fear.

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