The head of the nation’s largest publicly operated health plan is not alone in worrying about federal cuts to Medicaid. It’s personal.
The daughter of Mexican immigrants, Martha Santana-Chin grew up on Medi-Cal, California’s version of Medicaid, a government-run health care program for low-income and disabled people. Currently, she is CEO of LA Care, which operates the largest Medi-Cal health plan. The company has more than 2.2 million members, which exceeds enrollment in the U.S. Medicaid and Children’s Health Insurance programs. 41 states.
“Without safety nets like the Medi-Cal program, many people would be trapped in poverty without the ability to escape,” she said. “For me personally, not having to worry about my health care allows me to focus on what I need to focus on: my education.”
As LA Care enters its second year of operation, Santana-Chin is grappling with the challenges of federal and state spending cuts that are complicating the task of providing care to poor and medically vulnerable members of Medicaid. The insurer also offers Affordable Care Act Marketplace plans through Covered California.
Santana-Chin warns that the Republicans’ One Big Beautiful Bill Act, also known as HR 1, which was enacted last year, could result in 650,000 enrollees being taken off LA Care’s Medi-Cal rolls by the end of 2028. This could strain the plan’s finances as revenue declines. The insurer earned $11.7 billion in revenue last fiscal year.
HR 1 is expected to cut more than $900 billion from Medicaid over the next 10 years, including: Over $30 billion In California, according to the Department of Health Services, which operates Medi-Cal:
Like other states facing large deficits, California is freezing new registrations for immigrants without legal status. asset limit. And that’s before considering the spending cuts that states may need by withdrawing too much federal money under HR 1.
Santana-Chin took the helm at LA Care in January 2025, nearly three years after being removed from state regulators after overseeing for-profit insurer Health Net’s Medi-Cal and Medicare operations. LA Care fined $55 million They said the violations put the health and safety of members at risk. LA Care Payments $27 million in fines submitted to the state and agreed to contribute $28 million to community health projects.
In a wide-ranging interview, Santana-Chin spoke with KFF Health News Senior Correspondent Bernard J. Wolfson about the financial headwinds facing LA Care and why she believes health care should not be limited based on a person’s immigration status. This interview has been edited for length and clarity.
Question: You grew up on Medicaid. You now run one of the largest Medicaid plans in the country. How has this affected your view?
What really motivates me is knowing that many of the people we serve are like my family. They had a hard time and had to have their own children translate something that was very difficult to translate. I remember doing that for my mother. As you know, basic human dignity requires the right to health care.
Question: Does anything you’ve dealt with at Health Net or LA Care remind you of your childhood experiences in Medi-Cal?
At that time, transportation was not guaranteed and we did not have a car. One of the issues we’ll be hearing from members today is the need to ensure that reliable transportation arrives on time, with drivers who treat us courteously. If I had done that, if my mother had done that too, life would have been so much easier.
Q: What impact do you think HR1 will have?
The delivery system is broken. Clearly the state will not be able to make up the shortfall in federal funding, and over the next few years we will have less and less funding, and the number of people we cover will also decrease significantly. We expect 650,000 people to leave their job between now and the end of 2028. This is LA Care.
Question: That’s over a quarter of Medi-Cal enrollments.
Yes, it’s very important. Decreasing payments and increasing uncompensated care will really impact our delivery system. Accessibility will be impacted as delivery systems become unstable and hospitals and other health care providers are forced to close services or reduce the number of sites they have. And this doesn’t just affect people who lose their coverage.
Q: How does LA Care respond?
Obviously, we’re going to see a significant decrease in revenue. We are focused on making sure we operate as efficiently as possible. And we’re exploring creative ways to use technology to empower our people to perform at higher levels. It’s primarily supported by smart technology that helps call center agents answer questions and resolve issues faster. Part of that is automating the process on the claims payment side.
Q: Is there anything you would like to say to the Republican lawmakers who passed HR 1?
We are at an inflection point in our health care delivery system. And we must recognize that some components of HR 1 may have long-term unintended consequences. I have to believe that some of these are not. I think we need to rethink some of what was passed.
Q: For example?
Work requirements are an example of something many people believed was the right thing to do to keep their health care costs under control. This is very complicated and will cause people to lose coverage for which they actually qualify. It’s a shame, and I’d encourage people to reconsider.
Question: What impact do you anticipate will be from California’s decision to freeze Medi-Cal enrollment for immigrants without legal status?
It doesn’t matter what your immigration status is. If you are a human and need health care, you will try to get it wherever you can. If you are not insured, this can put a strain on our shipping system.
Q: What steps has LA Care taken to address state concerns about delays in approving treatment and processing patient complaints in 2022?
Over the past few years, significant investments have been made in LA Care infrastructure: IT platforms and data. There has also been significant investment in adding new capacity, adding bandwidth to many of our teams and more people to help support our operations.
Q: How has the federal immigration crackdown in LA affected LA Care members and the broader community?
It definitely had a cooling effect. Families are afraid to come home. They do not take their children to get vaccinated. Many providers in emergency rooms have reported a decline in the number of patients presenting to them. One of our case managers was truly distraught because she had an individual who decided to forgo serious life-saving treatment because of fear.
