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

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

If the head of the nation's largest public health insurance plan is worried about looming federal cuts to the Medicaid program, it's not just her job. It's personal.

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

“If there weren't safety nets like the Medi-Cal program, I think a lot of people would be stuck in poverty with no way to get out of it,” she said. “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 begins her second year as head of 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, passed last year, also known as HR 1, could result in 650,000 enrollees disappearing from LA Care's Medi-Cal rolls by the end of 2028. This will put a strain on the plan's finances as revenue declines. The insurer posted revenue of $11.7 billion in its last fiscal year.

According to the Department of Health and Human Services, which operates Medi-Cal, HR 1 is expected to save more than $900 billion from Medicaid over the next decade — including $30 billion or more in California.

Like other states facing large deficits, California has reduced its Medicaid spending through measures such as freezing new enrollments for undocumented immigrants and reinstating an asset limit. And that’s before the state anticipates the spending cuts likely to be required by the withdrawal of so many federal dollars under H.R. 1.

Santana-Chin led 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 compromised the health and safety of its members. LA Care paid $27 million in penalties to the state and agreed to contribute $28 million for community health projects.

In a wide-ranging interview, Santana-Chin spoke with KFF Health News senior correspondent Bernard J. Wolfson about the financial headwinds LA Care is facing 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.

Q: You grew up with Medicaid. How has that shaped your views now that you run one of the largest Medicaid plans in the country?

What really motivates me is knowing that many of the people we serve are just like my family. They had difficulties and had to have their own children translate things that were very difficult to translate. I remember doing this for my own mother. They know that human dignity requires access to medical care.

Q: Did anything you dealt with at Health Net or LA Care remind you of your childhood experiences at Medi-Cal?

At that time, transportation was not covered and we had no vehicle. One of the themes we are hearing from our members today is the need to ensure we have trustworthy 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?

It will destroy the delivery system. The state clearly will not be able to make up for the shortfalls in federal funding, and over the next few years funding will become increasingly smaller and the number of people we serve will decline significantly. We assume that 650,000 people will leave working life by the end of 2028. This is just LA Care.

Q: That's more than a quarter of your Medi-Cal enrollment.

Yes, it is very, very significant. The cuts in payments and the increase in uncompensated care will have a significant impact on our delivery system. As the delivery system is destabilized and hospitals and other healthcare providers are forced to close services or reduce the number of locations, this will impact access. And it won't just affect those who lose insurance coverage.

Q: How will LA Care respond?

Obviously we will see a significant decline in sales. We attach great importance to ensuring that we work as efficiently as possible. And we look for creative ways to use technology to empower our employees to perform tasks at higher levels. Mainly, we support our call center agents with smarter technology that helps them answer questions faster and resolve problems faster. Part of this is automating processes on the claims payment side.

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

We are at a turning point in the healthcare system. And we must recognize that some of the components of HR 1 will have long-term unintended consequences - perhaps they were intended; I have to believe that some of these things aren't the case. There is probably a need to reconsider some of the things adopted.

Q: How for example?

Work requirements are an example of something that many people believed was the right thing to do to make good use of health care money. It is very complex and will cause people to lose coverage that actually qualifies. This is unfortunate and I would urge people to reconsider.

Q: What impact do you expect from California's decision to freeze medical school enrollment for undocumented immigrants?

It doesn't matter what your immigration status is. If you are human and need healthcare, you will try to access healthcare wherever you can. If you are not insured it will put a strain on the delivery system.

Q: What has LA Care done to address the state's concerns in 2022 that it has delayed approving care and addressing patient complaints?

Over the last few years, there has been a lot of investment in LA Care's infrastructure - our IT platforms, our data. There is also a lot of investment being made to add new capacity, expand bandwidth for many teams and provide more people to support the work.

Q: How have federal immigration raids in LA impacted LA Care members and the broader community?

It had an absolutely chilling effect. Families are afraid to come in. They don't take their children with them to get vaccinated. I have heard from numerous emergency room providers that the number of patients reporting has decreased. One of our case managers was truly distraught because a person was foregoing serious life-saving treatment out of fear.

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