Martha Santana-Chin carries the weight of millions on her shoulders, but her concern for the future of Medicaid isn’t simply professional – it’s deeply personal. As CEO of L.A. Care, the nation’s largest publicly operated health plan, she’s bracing for potentially devastating federal cuts, and the prospect cuts close to home.
Santana-Chin’s own story began as the daughter of Mexican immigrants, relying on Medi-Cal, California’s version of Medicaid, for essential healthcare. She remembers a childhood where access to care wasn’t a given, but a lifeline. Today, she leads an organization serving over 2.2 million people – more than the entire Medicaid enrollment of 41 states.
“Without programs like Medi-Cal,” she reflects, “so many would remain trapped in poverty, unable to build a better future.” For Santana-Chin, having healthcare security wasn’t just about physical well-being; it allowed her to focus on her education, the very foundation of her success.
Now, entering her second year at L.A. Care’s helm, she faces a looming crisis. Federal and state spending cuts threaten to unravel the safety net she once depended on, complicating the already challenging task of providing care to the most vulnerable.
A recently enacted federal bill, known as HR 1, poses a significant threat. L.A. Care projects a loss of 650,000 enrollees by the end of 2028, a staggering blow that will severely strain the plan’s financial stability. The potential cuts to Medicaid are immense – exceeding $900 billion nationally, with California facing a loss of $30 billion or more.
California is already responding to budget pressures by limiting access, freezing enrollment for undocumented immigrants and reinstating asset limits. These measures are just a prelude to the deeper cuts anticipated with the reduction in federal funding.
Santana-Chin brings a wealth of experience to this fight, having previously overseen Medi-Cal and Medicare operations for a for-profit insurer. She took leadership of L.A. Care after the plan addressed past regulatory concerns, investing significantly in improvements to ensure member safety and quality of care.
In a candid discussion, Santana-Chin shared her perspective on the challenges facing L.A. Care and her unwavering belief that healthcare is a fundamental human right, regardless of immigration status. She spoke of the profound impact of early experiences on her current mission.
She vividly recalls the struggles of her family, the need for her to translate complex medical information for her mother, and the lack of basic support like transportation to appointments. “Basic human dignity requires access to healthcare,” she asserts, remembering a time when even something as simple as a ride to the doctor felt insurmountable.
The impact of HR 1, she warns, will be “devastating” to the healthcare delivery system. The state won’t be able to fully offset the federal cuts, leading to reduced funding and a significant decline in coverage. The projected loss of 650,000 enrollees at L.A. Care alone is a stark illustration of the potential fallout.
“It’s not only going to impact those that lose coverage,” she emphasizes. Reduced payments and increased uncompensated care will destabilize the entire system, potentially forcing hospitals and clinics to reduce services or even close their doors, limiting access for everyone.
L.A. Care is responding by focusing on efficiency and leveraging technology to empower its workforce. Investments are being made in smarter tools for call center agents and automation of claims processing, all aimed at maximizing resources and improving service.
Santana-Chin doesn’t shy away from directly addressing the lawmakers behind HR 1. She urges them to reconsider the long-term consequences of their decisions, acknowledging that some impacts may have been unintended. She believes a careful reevaluation is crucial.
Specifically, she questions the effectiveness of work requirements, arguing they are overly complex and will ultimately lead to coverage loss for those who genuinely qualify. She urges a more compassionate and practical approach.
California’s decision to freeze Medi-Cal enrollment for undocumented immigrants also raises concerns. Santana-Chin points out that denying care based on immigration status doesn’t eliminate the need; it simply drives people underground, straining the system further when they inevitably seek care in emergency situations.
L.A. Care has made substantial investments in its infrastructure, upgrading IT platforms and expanding team capacity to address past concerns about care authorization and grievance resolution. These improvements are designed to ensure members receive timely and appropriate care.
The climate of fear created by federal immigration raids is also taking a toll. Providers report a decline in patient visits, particularly for preventative care like vaccinations. Santana-Chin recounts a heartbreaking story of a patient who chose to forgo life-saving treatment out of fear of deportation.
For Martha Santana-Chin, this isn’t just about policy or finances; it’s about people. It’s about ensuring that the same opportunities she had – the chance to focus on education and build a life – are available to everyone, regardless of their background or circumstances.
