\u201cIf it weren\u2019t for safety nets like the Medi-Cal program, I think, many people would be stuck in poverty without an ability to get out,\u201d she said. \u201cFor 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.\u201d<\/p>\n
As she begins her second year steering L.A. Care, Santana-Chin is grappling with federal and state spending cuts that complicate her task of providing health care to the poor and medically vulnerable enrollees in Medicaid. The insurer also provides Affordable Care Act marketplace plans through Covered California.<\/p>\n
Santana-Chin warns that the GOP\u2019s One Big Beautiful Bill Act, enacted last year and also known as HR 1, could result in 650,000 enrollees falling off L.A. Care\u2019s Medi-Cal rolls by the end of 2028. This will strain the plan\u2019s finances as revenues decline. The insurer had revenues of $11.7 billion in the last fiscal year.<\/p>\n
HR 1 is expected to cut more than $900 billion from Medicaid over the next 10 years \u2014 including $30 billion or more<\/a> in California, according to the Department of Health Care Services, which runs Medi-Cal.<\/p>\n Like other states facing big deficits, California has reduced its Medicaid spending through such steps as freezing new enrollments for immigrants without legal status and reintroducing an asset limit<\/a>. And that\u2019s before the state reckons with the spending cuts that likely will be required by the withdrawal of so many federal dollars under HR 1.<\/p>\n Santana-Chin oversaw Medi-Cal and Medicare operations for the for-profit insurer Health Net before taking the helm of L.A. Care in January 2025, nearly three years after state regulators fined L.A. Care $55 million<\/a> over violations they said compromised the health and safety of its members. L.A. Care paid $27 million in penalties<\/a> to the state and agreed to contribute $28 million to community health projects.<\/p>\n In a wide-ranging interview, Santana-Chin talked to KFF Health News senior correspondent Bernard J. Wolfson about the financial headwinds facing L.A. Care and why she believes health care shouldn\u2019t be restricted based on a person\u2019s immigration status. This interview has been edited for length and clarity.<\/p>\n Q: You grew up on Medicaid. How has that shaped your views now that you run one of the largest Medicaid plans in the country?<\/strong><\/p>\n What really motivates me is knowing that many of the people that we\u2019re serving are just like my family. They\u2019ve struggled and have had to have their own children translate things that were very difficult to translate. I remember doing that for my own mother. You know, basic human dignity requires that you have access to health care.<\/p>\n Q: Has anything you\u2019ve dealt with at Health Net or L.A. Care reminded you of your childhood experiences in Medi-Cal?<\/strong><\/p>\n Back then they didn\u2019t cover transportation, and we didn\u2019t have a vehicle. Today, one of the issues we\u2019ll hear from our members is the need to make sure we have trustworthy transportation that shows up on time, where the drivers treat them with respect. Had I had that, had my mother had that, life would have been much easier.<\/p>\n Q: What do you think the impact of HR 1 will be?<\/strong><\/p>\n It\u2019s going to devastate the delivery system. The state obviously isn\u2019t going to be able to make up for the shortfalls in federal funding, and over the course of the next several years, funding is going to be less and less, and the people we cover are going to decrease significantly. We are expecting between now and the end of 2028 that we\u2019re going to see 650,000 people drop off the rolls. That\u2019s just L.A. Care.<\/p>\n Q: That\u2019s over a quarter of your Medi-Cal enrollment.<\/strong><\/p>\n Yes, it\u2019s very, very significant. The reductions in payment and the rise in uncompensated care are really going to impact our delivery system. As the delivery system gets destabilized and hospitals and other health care providers are forced to close services or reduce the number of sites they have, it\u2019s going to impact access. And it\u2019s not only going to impact those that lose coverage.<\/p>\n Q: How will L.A. Care respond?<\/strong><\/p>\n Obviously, we\u2019re going to see a significant drop in revenue. We\u2019re very focused on making sure that we are operating as efficiently as we can operate. And we are looking at creative ways to use technology to empower our people to do higher-level work. Mostly supporting our call center agents with smarter technology that helps them answer questions and resolve problems more quickly. Some of it is automating processes on the claims payment side.<\/p>\n Q: What do you have to say to congressional Republicans who passed HR 1?<\/strong><\/p>\n We are at a point of inflection in the health care delivery system. And we have to recognize that some of the components of HR 1 will have long-term unintended consequences \u2014 maybe they were intended; I\u2019ve got to believe that some of these things are not. There\u2019s probably a need to reconsider some of the things that were passed.<\/p>\n Q: Such as?<\/strong><\/p>\n Work requirements are an example of something that many people did believe was the right thing to do to be good stewards of the health care dollar. It is very complex and is going to cause people to lose coverage that actually do qualify. It\u2019s unfortunate, and that would be something that I would urge folks to reconsider.<\/p>\n Q: What impact do you expect from California\u2019s decision to freeze Medi-Cal enrollment for immigrants without legal status?<\/strong><\/p>\n It doesn\u2019t matter what immigration status you are. If you are a human being and you need health care, you\u2019re going to try to access health care wherever you can. That\u2019s going to put a strain on the delivery system if you\u2019re uninsured.<\/p>\n Q: What has L.A. Care done to address the state\u2019s concerns in 2022 that it delayed authorizing care and addressing patient grievances?<\/strong><\/p>\n There has been quite a bit of investment in the L.A. Care infrastructure over the last several years \u2014 our IT platforms, our data. There\u2019s also quite a bit of investment in adding new capacity, adding bandwidth to many of the teams, more folks to help support the work.<\/p>\n Q: How have federal immigration raids in L.A. affected L.A. Care members and the broader community?<\/strong><\/p>\n It absolutely has had a chilling effect. Families are afraid to come in. They\u2019re not taking their children to get vaccinated. I\u2019ve had numerous providers in emergency departments say that they have experienced a drop in the volume of individuals coming in. One of our case managers was really distraught because there was an individual that decided to forgo serious lifesaving treatment because of fear.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"http:\/\/commandcancel.com\/wp-content\/uploads\/2026\/01\/Santana-Chin_02-scaled.jpg\")
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