GOP Cuts Will Cripple Medicaid Enrollment, Warns CEO of Largest Public Health Plan

When the top of the nation’s largest publicly operated well being plan worries concerning the looming federal cuts to Medicaid, it’s not simply her job. It’s private.

Martha Santana-Chin, the daughter of Mexican immigrants, grew up on Medi-Cal, California’s model of Medicaid, the government-run well being care program for individuals with low incomes and disabilities. In the present day, she is CEO of L.A. Care, which runs by far the largest Medi-Cal well being plan, with greater than 2.2 million enrollees, exceeding the Medicaid and Youngsters’s Well being Insurance coverage Program enrollments in 41 states.

“If it weren’t for security nets just like the Medi-Cal program, I feel, many individuals could be caught in poverty with out a capability to get out,” she stated. “For me personally, not having to fret about well being care allowed me to actually give attention to what I wanted to give attention to, which was my training.”

As she begins her second yr steering L.A. Care, Santana-Chin is grappling with federal and state spending cuts that complicate her process of offering well being care to the poor and medically weak enrollees in Medicaid. The insurer additionally offers Inexpensive Care Act market plans by means of Lined California.

Santana-Chin warns that the GOP’s One Huge Lovely Invoice Act, enacted final yr and also called HR 1, might end in 650,000 enrollees falling off L.A. Care’s Medi-Cal rolls by the top of 2028. This can pressure the plan’s funds as revenues decline. The insurer had revenues of $11.7 billion within the final fiscal yr.

HR 1 is predicted to chop greater than $900 billion from Medicaid over the following 10 years — together with $30 billion or more in California, in keeping with the Division of Well being Care Providers, which runs Medi-Cal.

Like different states dealing with huge deficits, California has decreased its Medicaid spending by means of such steps as freezing new enrollments for immigrants with out authorized standing and reintroducing an asset limit. And that’s earlier than the state reckons with the spending cuts that seemingly will probably be required by the withdrawal of so many federal {dollars} beneath HR 1.

Santana-Chin oversaw Medi-Cal and Medicare operations for the for-profit insurer Well being Internet earlier than taking the helm of L.A. Care in January 2025, practically three years after state regulators fined L.A. Care $55 million over violations they stated compromised the well being and security of its members. L.A. Care paid $27 million in penalties to the state and agreed to contribute $28 million to neighborhood well being initiatives.

In a wide-ranging interview, Santana-Chin talked to KFF Well being Information senior correspondent Bernard J. Wolfson concerning the monetary headwinds dealing with L.A. Care and why she believes well being care shouldn’t be restricted based mostly on an individual’s immigration standing. This interview has been edited for size and readability.

Q: You grew up on Medicaid. How has that formed your views now that you just run one of many largest Medicaid plans within the nation?

What actually motivates me is understanding that most of the people who we’re serving are identical to my household. They’ve struggled and have needed to have their very own youngsters translate issues that have been very troublesome to translate. I keep in mind doing that for my very own mom. You realize, primary human dignity requires that you’ve entry to well being care.

Q: Has something you’ve handled at Well being Internet or L.A. Care reminded you of your childhood experiences in Medi-Cal?

Again then they didn’t cowl transportation, and we didn’t have a car. In the present day, one of many points we’ll hear from our members is the necessity to ensure we now have reliable transportation that exhibits up on time, the place the drivers deal with them with respect. Had I had that, had my mom had that, life would have been a lot simpler.

Q: What do you assume the influence of HR 1 will probably be?

It’s going to devastate the supply system. The state clearly isn’t going to have the ability to make up for the shortfalls in federal funding, and over the course of the following a number of years, funding goes to be much less and fewer, and the individuals we cowl are going to lower considerably. We expect between now and the top of 2028 that we’re going to see 650,000 individuals drop off the rolls. That’s simply L.A. Care.

Q: That’s over 1 / 4 of your Medi-Cal enrollment.

Sure, it’s very, very important. The reductions in cost and the rise in uncompensated care are actually going to influence our supply system. Because the supply system will get destabilized and hospitals and different well being care suppliers are pressured to shut providers or scale back the variety of websites they’ve, it’s going to influence entry. And it’s not solely going to influence those who lose protection.

Q: How will L.A. Care reply?

Clearly, we’re going to see a big drop in income. We’re very centered on ensuring that we’re working as effectively as we will function. And we’re artistic methods to make use of expertise to empower our individuals to do higher-level work. Principally supporting our name middle brokers with smarter expertise that helps them reply questions and resolve issues extra rapidly. A few of it’s automating processes on the claims cost aspect.

Q: What do you need to say to congressional Republicans who handed HR 1?

We’re at some extent of inflection within the well being care supply system. And we now have to acknowledge that among the elements of HR 1 can have long-term unintended penalties — possibly they have been supposed; I’ve acquired to imagine that a few of these issues will not be. There’s in all probability a must rethink among the issues that have been handed.

Q: Reminiscent of?

Work necessities are an instance of one thing that many individuals did imagine was the precise factor to do to be good stewards of the well being care greenback. It is rather complicated and goes to trigger individuals to lose protection that really do qualify. It’s unlucky, and that might be one thing that I’d urge people to rethink.

Q: What influence do you count on from California’s resolution to freeze Medi-Cal enrollment for immigrants with out authorized standing?

It doesn’t matter what immigration standing you’re. In case you are a human being and also you want well being care, you’re going to attempt to entry well being care wherever you’ll be able to. That’s going to place a pressure on the supply system should you’re uninsured.

Q: What has L.A. Care executed to handle the state’s considerations in 2022 that it delayed authorizing care and addressing affected person grievances?

There was fairly a little bit of funding within the L.A. Care infrastructure during the last a number of years — our IT platforms, our information. There’s additionally fairly a little bit of funding in including new capability, including bandwidth to most of the groups, extra people to assist help the work.

Q: How have federal immigration raids in L.A. affected L.A. Care members and the broader neighborhood?

It completely has had a chilling impact. Households are afraid to come back in. They’re not taking their youngsters to get vaccinated. I’ve had quite a few suppliers in emergency departments say that they’ve skilled a drop within the quantity of people coming in. One among our case managers was actually distraught as a result of there was a person that determined to forgo severe lifesaving therapy due to concern.